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European Heart Journal Advance Access published online on February 23, 2005
European Heart Journal, doi:10.1093/eurheartj/ehi150
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European Heart Journal © The European Society of Cardiology 2005; all rights reserved

Clinical research

Do statins influence the prognostic impact of non-sustained ventricular tachycardia after ST-elevation myocardial infarction?

H. Lorenz 1, C. Jünger 1, K. Seidl 1, A. Gitt 1, S. Schneider 1, R. Schiele 1, H. Wienbergen 1, R. Winkler 1, M. Gottwik 2, W. Delius 3, J. Senges 1, and B. Rauch 1*

1 Institut für Herzinfarktforschung, Klinikum der Stadt Ludwigshafen, Bremserstr. 79, D-67063 Ludwigshafen am Rhein, Herzzentrum Ludwigshafen, Germany
2 Klinikum Nürnberg Süd, Kardiologie, Nürnberg, Germany
3 Städtisches Krankenhaus München-Bogenhausen, Germany

* To whom correspondence should be addressed.
B. Rauch, E-mail: rauchb{at}klilu.de


  Abstract

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.

Keywords: ST-elevation myocardial infarction; Statin; Non-sustained ventricular tachycardia; Prognosis; Risk stratification; Pleiotropic effect.
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