European Heart Journal Advance Access originally published online on February 23, 2005
European Heart Journal 2005 26(11):1078-1085; doi:10.1093/eurheartj/ehi150
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Do statins influence the prognostic impact of non-sustained ventricular tachycardia after ST-elevation myocardial infarction?
1Institut für Herzinfarktforschung, Klinikum der Stadt Ludwigshafen, Bremserstr. 79, D-67063 Ludwigshafen am Rhein, Herzzentrum Ludwigshafen, Germany
2Klinikum Nürnberg Süd, Kardiologie, Nürnberg, Germany
3Städtisches Krankenhaus München-Bogenhausen, Germany
Received 26 July 2004; revised 17 December 2004; accepted 23 December 2004; online publish-ahead-of-print 23 February 2005.
* Corresponding author. Tel: +49 621 5032850; fax: +49 621 5032882. E-mail address: rauchb{at}klilu.de
Aims The study evaluates the effect of statin therapy on the prognostic impact of non-sustained ventricular tachycardia (NSVT) occurring after acute ST-elevation myocardial infarction (STEMI).
Methods and results From the German Acute Coronary Syndrome Registry (ACOS), 3137 patients with STEMI and in-hospital Holter monitoring were analysed. Three hundred and forty-six (11.0%) patients had NSVT. When compared with patients with no documented NSVT, patients with NSVT were older, more often had myocardial infarction in their history, diabetes mellitus, and an ejection fraction <40%. Regarding frequency of drug application, medication at discharge did not (beta-blockers, ACE-inhibitors, amiodarone) or only slightly (acetylsalicylic acid, statins, and sotalol) differ between both groups. Multivariable analysis of 1 year mortality, adjusted for age, gender, diabetes, reperfusion therapy, ejection fraction <40%, and beta-blocker therapy showed the following results: In patients without statin treatment and no NSVT, 1 year mortality after STEMI was 9.2%, but increased to 25.0% [odds ratio (OR) 3.02; 95% confidence interval (CI) 1.47–6.20], if NSVT were present. In patients on statin treatment and no NSVT, 1 year mortality was only 3.2%, and in the presence of NSVT 1 year mortality was not significantly increased anymore (5.3%; OR 1.03; 95% CI 0.55–1.92).
Conclusion After STEMI, only in patients not on statin treatment, the occurrence of NSVT is associated with a significant and marked increase in 1 year mortality.
Key Words: ST-elevation myocardial infarction • Statin • Non-sustained ventricular tachycardia • Prognosis • Risk stratification • Pleiotropic effect
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