Incidence, timing, predictors, and impact of sustained ventricular arrythmias complicating ST-segment elevation myocardial infarction

Abstract

To describe the incidence, predictors, and in-hospital impact of early SVA (eSVA, occurring < day 2 post-STEMI) and late SVA (lSVA, occurring ≥ day 2 post-STEMI) in STEMI patients. To derive and internally validate a risk score to identify patients at high-risk of lSVA. Data of 13523 patients enrolled in the ORBI registry were analysed. Logistic regression was performed to identify predictors of eSVA, lSVA, and in-hospital all-cause mortality. Predictors of lSVA were used to build a risk score. eSVA occurred in 678 patients (5%) whereas 120 patients (0.9%) experienced lSVA at a median timing of 3 days post-STEMI. eSVA associated with a significantly higher risk of all-cause mortality (adjusted OR: 1.90, 95%CI: 1.39–2.61, P < 0.001) whereas only a trend was observed with lSVA (adjusted OR: 1.69, 95%CI: 0.91–3.13, P = 0.09). Multivariable predictors of eSVA are listed in Table 1 . Multivariable predictors of lSVA are listed in the Figure. The score derived from these variables allowed the classification of patients into four risk categories: low (0–21), low-to-intermediate (22–34), intermediate-to-high (35–44), and high (≥ 45). Observed lSVA rates were 0.2%, 0.4%, 0.8%, and 2.5%, across the four risk categories, respectively. The model demonstrated good discrimination (20-fold cross-validated c-statistic of 0.76) and adequate calibration (Hosmer-Lemeshow P = 0.40). eSVA are 5-fold more common than lSVA in the setting of STEMI, mainly associated with other early complications, and portends a 2-fold higher risk of in-hospital mortality. Moreover, we developed a risk score-identifying patients at high risk of lSVA for whom early ICU discharge may not be suitable.