Abstract 9221: Long-Term Risk of New-Onset Arrhythmia in Patients With ST-Segment Elevation Myocardial Infarction According to Revascularization Status

Abstract

Introduction: Emerging data show that complete revascularization reduces cardiovascular death and recurrent myocardial infarction in ST-segment elevation myocardial infarction (STEMI). The influence of revascularization status on development of arrhythmia in the chronic post-STEMI phase is poorly described. Hypothesis: We hypothesized that incomplete compared with complete revascularization in STEMI is associated with an increased long-term risk of new-onset arrhythmia. Methods: Using unique Danish registries, the risk of new-onset arrhythmia was assessed in STEMI with complete or incomplete revascularization after primary percutaneous coronary intervention (PPCI) at Rigshospitalet University Hospital, Denmark, from 2009-2016. The primary outcome was new-onset arrhythmia defined as a composite of atrial fibrillation/flutter, sinoatrial dysfunction, advanced 2nd- or 3rd-degree atrioventricular block, ventricular tachycardia/fibrillation, cardiac arrest, or pacemaker/ICD implantation, with presentation >7 days post-PPCI. Secondary outcome was all-cause mortality. Results: A total of 5,062 patients (median age: 62.0 years; 76% men) were included, of which 3,985 and 1,077 patients underwent complete and incomplete revascularization, respectively. During a median follow-up of 4.9 years, 580 (15%) patients in the complete and 217 (20%) patients in the incomplete revascularization group were diagnosed with new-onset arrhythmia (Figure 1). Compared with complete revascularization, incomplete revascularization was associated with a higher risk of new-onset arrhythmia (adjusted hazard ratio [HR] 1.3; 95% CI, 1.1-1.5; P=0.004) and higher all-cause mortality (adjusted HR 1.3; 95% CI, 1.0-1.5; P=0.02). Conclusions: Incomplete revascularization in STEMI was associated with an increased long-term risk of new-onset arrhythmia and all-cause mortality compared with complete revascularization.