European Heart Journal Advance Access originally published online on June 14, 2006
European Heart Journal 2006 27(14):1706-1711; doi:10.1093/eurheartj/ehl100
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Incidence, time course, and predictors of early malignant ventricular arrhythmias after non-ST-segment elevation myocardial infarction in patients with early invasive treatment
1 Department of Internal Medicine/Cardiology, Heart Center, University of Leipzig, Leipzig, Germany
2 Department of General Medicine, King's College Hospital, Bessemer Road, London SE5 9RS, UK
Received 1 March 2006; revised 24 May 2006; accepted 26 May 2006; online publish-ahead-of-print 14 June 2006.
* Corresponding author. Tel: +49 341 865 1428; fax: +49 341 865 1177. E-mail address: krahimi{at}freenet.de
Aims The incidence of non-ST-segment elevation myocardial infarction (NSTEMI) is increasing. With the limited intensive care facilities, knowledge of the total risk and predictors of acute life-threatening arrhythmias is of major interest to guide the decision on the intensity of care at the time of admission.
Methods and results We continuously monitored 588 consecutive patients with NSTEMI admitted to the coronary care unit of a primary and tertiary care centre for malignant ventricular arrhythmias requiring defibrillation. Ninety-seven per cent of the patients underwent coronary angiography during the index hospital admission. Total rate of malignant ventricular arrhythmias and mortality was 2.6% (n=15) and 3.6% (n=21), respectively. More than two-thirds of arrhythmias occurred within the first 12 h after onset of symptoms. In a bootstrapped multivariable regression analysis, the only factor associated with the occurrence of malignant ventricular arrhythmia was higher white blood cell count on admission. Popular risk assessment tools such as Thrombolysis in Myocardial Infarction, Platelet glycoprotein IIb/IIIa in Unstable angina: Receptor Suppression Using Integrilin Therapy, and Predicting Risk of Death in Cardiac disease Tool were predictive of mortality but not of early arrhythmia.
Conclusion Patients with NSTEMI treated aggressively with early revascularization are at low risk for developing life-threatening arrhythmias. The occurrence of such events remains difficult to predict. The role of baseline inflammatory status as a determinant merits further investigations.
Key Words: Burden of illness • Myocardial infarction • Tachyarrhythmias • Risk factors • Leukocyte
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