B-PO05-188 FACTORS THAT PREDICT VENTRICULAR ARRHYTHMIAS IN THE LATE PHASE AFTER ACUTE MYOCARDIAL INFARCTION

Abstract

Patients with a left ventricular ejection fraction (LVEF) of ≤40% after acute myocardial infarction (AMI) have an increased risk of sudden cardiac death and mortality. Non-sustained ventricular tachyarrhythmia, which is often documented in the acute phase after AMI, is also a reported risk factor for ventricular tachycardia or ventricular fibrillation in patients with reduced LVEF. However, little is known regarding which patients with heart failure after AMI should be considered for prophylactic therapies, such as an implantable cardioverter defibrillator. This observational cohort study aimed to identify factors that predicted lethal VAs during the late phase after AMI in patients with reduced LVEF. Data were collected from our AMI database regarding consecutive patients with a LVEF of ≤40% after AMI (January 2012 to July 2018). The “late phase” was defined as ≥7 days after AMI onset and the primary endpoint was defined as lethal VAs in the late phase. The study included 136 patients (82% men; mean age: 66 ± 13 years). The average LVEF at admission was 32.7 ± 8.2%. During a mean follow-up of 20.7 months, 14 patients (10%) experienced lethal VAs, including ventricular fibrillation (n = 8) and sustained ventricular tachycardia (n = 10). Univariate analyses revealed that lethal VAs were predicted by age and the LVEF at admission. Receiver operating characteristic curve analysis revealed that the optimal cut-off value was 23% for using the LVEF at admission to predict the primary endpoint (area under the curve: 0.77, p < 0.0001). Multivariable analysis also demonstrated that LVEF at admission was an independent predictor of the primary endpoint (risk ratio = 7.12, p = 0.001). Lethal VAs in the late phase are common in patients with AMI and reduced LVEF, and cardiac function at admission plays a significant role in the risk stratification for future lethal VAs in this population.