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European Heart Journal Advance Access originally published online on January 16, 2007
European Heart Journal 2007 28(4):407-414; doi:10.1093/eurheartj/ehl476
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© The European Society of Cardiology 2007. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Prevalence and prognostic implications of non-sustained ventricular tachycardia in ST-segment elevation myocardial infarction after revascularization with either fibrinolysis or primary angioplasty

Dan Eik Høfsten1,*, Kristian Wachtell3, Birgit Lund2, Henning Mølgaard2, Kenneth Egstrup on behalf of the DANAMI-2 Investigators1

1 Department of Medical Research, Svendborg Hospital, 5700 Svendborg, Denmark
2 Department of Cardiology, Skejby Sygehus, Århus University Hospital, Århus, Denmark
3 Department of Cardiology, Rigshospitalet, Copenhagen, Denmark

Received 6 July 2006; revised 19 December 2006; accepted 21 December 2006; online publish-ahead-of-print 16 January 2007.

* Corresponding author. Tel: +45 6320 2404; fax: +45 6320 2407. E-mail address: dan{at}hoefsten.dk

Aims We compared the prevalence and prognostic implications of non-sustained ventricular tachycardia (nsVT) detected early after ST-segment elevation myocardial infarction (STEMI) in patients randomized to either fibrinolysis or primary angioplasty in the DANAMI-2 trial.

Methods and results Holter recordings were available in 1017 patients (fibrinolysis: n = 501; primary angioplasty: n = 516). Primary endpoint was all-cause mortality. The prevalence of nsVT was 8.8% in fibrinolysis-treated, and 8.1% in primary angioplasty-treated patients (P = 0.71). During 4519 patient-years of follow-up (median 4.3 years), 116 patients died [fibrinolysis vs. angioplasty: HR = 1.1 (95% CI, 0.8–1.6), P = 0.47]. In univariate analysis, nsVT patients treated with fibrinolysis, had significantly higher mortality when compared with those without nsVT (P < 0.001). However, after adjustment for other relevant prespecified risk factors, the association between nsVT and mortality did not remain statistically significant. In patients treated with primary angioplasty, nsVT was not associated with mortality in either univariate or multivariate analyses.

Conclusion Immediate revascularization with primary angioplasty for STEMI does not affect the subsequent prevalence of nsVT when compared with fibrinolysis. After adjustment for other relevant risk factors, the prognostic value of nsVT detected early after STEMI is limited, regardless of the chosen reperfusion strategy.

Key Words: Myocardial infarction • Angioplasty • Risk factors • Arrhythmia • Electrocardiography


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