Prognostic implications of early monomorphic and non–monomorphic tachyarrhythmias in patients discharged with acute coronary syndrome

Abstract

Background: The prognostic implication of early ventricular tachyarrhythmias (VTs) after acute coronary syndrome (ACS) remains unclear. Objective: We sought to investigate the clinical outcomes of early monomorphic and non–monomorphic VTs that occur within 48 hours in patients after ACS. Methods: We retrospectively reviewed the clinical outcomes of 2033 [mean age 67.0 ± 13.4 years; 1486 (73.1%) men] consecutive patients who presented with ACS from 2004 to 2015. Results: A total of 67 (3.3%) and 90 (4.4%) patients developed early monomorphic or non–monomorphic VT, respectively. Killip class IV (odds ratio [OR] 3.05; 95% confidence interval [CI] 1.47–6.36; P <.01), creatine kinase level (OR 1.01; 95% CI 1.00–1.02 per 100 IU/L; P =.01), and left ventricular ejection fraction (OR 0.96; 95% CI 0.94–0.99; P <.01) were independently associated with early monomorphic VT, whereas age (OR 0.98; 95% CI 0.97–0.99; P =.04), ST elevated myocardial infarction (OR 3.53; 95% CI 1.71–7.27; P <.01), Killip class IV (OR 4.91; 95% CI 2.76–8.74; P <.01), diabetes mellitus (OR 0.48; 95% CI 0.28–0.81; P <.01), and left ventricular ejection fraction (OR 0.97; 95% CI 0.95–0.99; P <.01) were independently associated with early non–monomorphic VT. More patients with early monomorphic VT (n = 22 [32.8%]) died in hospital than those with non–monomorphic VT (n = 16 [17.8%]) or without early VT (n = 133 [7.1%]; P <.01). After a mean follow-up of 67.8 ± 43.2 months, 21 patients with early monomorphic VT (46.7%), 22 patients with early non–monomorphic VT (29.7%), and 552 patients without early VT (31.7%) died. Both early monomorphic and non–monomorphic VTs were associated with a long-term increase in sudden arrhythmic deaths and recurrent VTs. Nevertheless, only early monomorphic VT was shown to independently predict overall survival (hazard ratio 1.62; 95% CI 1.03–2.55; P =.04). Conclusion: Early monomorphic VT, but not early non–monomorphic VT, independently predicted all-cause mortality in patients with ACS who survived to hospital discharge.