Po-04-171 life-threatening ventricular arrhythmias during st-elevation myocardial infarction is associated with increased risk of recurrent arrhythmic complications in case of repeated acute coronary syndrome

Early ventricular arrhythmias necessitating resuscitation efforts and defibrillation (VA) during the course of ST-elevation myocardial infarction (STEMI) are known to markedly contribute to increased in-hospital mortality, but do not influence the long-term prognosis of patients discharged alive. However, it is unclear whether these patients are at a higher risk of recurrent VA in case of recurrent acute ischemia. Our aim was to analyze whether the patients suffered from VA during STEMI are at risk of recurrent VA during repeated acute coronary syndrome (ACS). STEMI patients admitted to a tertiary care hospital for primary PCI during four years (2007-2010) comprised the study group. The Swedish national SWEDEHEART registry was used for assessment of clinical characteristics, angiography findings and the presence of VA during index admission. All VA occurrences were verified in medical records. The registry was also used to get information concerning repeated admissions for acute ischemic events (STEMI, non-STEMI or unstable angina) during follow-up period until December 31, 2017. The information about survival status and the cause of death was obtained from National Cause of Death Register. Cases of sudden death during follow-up with postmortem diagnosis of coronary artery disease were considered as possible arrhythmic complications of ACS; and taken for source data verification. VA occurrence during repeated ACS was compared between patients who had VA and those who did not have VA during index admission with STEMI. 2277 consecutive STEMI patients admitted for primary PCI were included (age 66±12 years, 70% male). VA during index STEMI was documented in 206 patients (9%, age 66±12 years, 75% male). During follow-up, 162 patients (age 63±12 years, 77% male) were readmitted with ACS. 55 patients received implantable cardioverter-defibrillator (ICD) after index STEMI; 2 patients had ICD when they developed re-ACS. Patients who had VA during index STEMI more often suffered from VA during repeated ACS (35.7% vs 4.1%, p<0.001). VA during the index STEMI remained independent predictor of recurrent VF during repeated ischemic events after adjustment for age, gender and left main occlusion (OR=8.8595%CI 1.79-43.66; p=0.007). Despite generally benign long-term prognosis of discharged alive STEMI patients with early VA, they remain at risk of recurrent arrhythmic complications in case of repeated ischemic events.