Sustained Ventricular Arrhythmias in Patients Receiving Thrombolytic Therapy : Incidence and Outcomes

K. H. Newby, T. Thompson, A. Stebbins, E. J. Topol, R. M. Califf, A. Natale
1998 Circulation  
MD; for the GUSTO Investigators Background-Sustained ventricular tachycardia (VT) and fibrillation (VF) occur in up to 20% of patients with acute myocardial infarction (MI) and have been associated with a poor prognosis. The relationships among the type of arrhythmia (VT versus VF or both), time of VT/VF occurrence, use of thrombolytic agents, and eventual outcome are unclear. Methods and Results-In the GUSTO-I study, we examined variables associated with the occurrence of VT/VF and its impact
more » ... /VF and its impact on mortality. Of the 40 895 patients with ventricular arrhythmia data, 4188 (10.2%) had sustained VT, VF, or both. Older age, systemic hypertension, previous MI, Killip class, anterior infarct, and depressed ejection fraction were associated with a higher risk of sustained VT and VF (PϽ0.001). In-hospital and 30-day mortality rates were higher among patients with sustained VT/VF than among patients without sustained ventricular arrhythmias (PϽ0.001). Both early (Ͻ2 days) and late (Ͼ2 days) occurrences of sustained VT and VF were associated with a higher risk of later mortality (PϽ0.001). In addition, patients with both VT and VF had worse outcomes than those with either VT or VF alone (PϽ0.001). Among patients who survived hospitalization, no significant difference was found in 30-day mortality between the VT/VF and no VT/VF groups. However, after 1 year, the mortality rate was significantly higher in the VT alone and VT/VF groups (PϽ0.0001). Conclusions-Despite the use of thrombolytic therapy, both early and late occurrences of sustained VT or VF continue to have a negative impact on patient outcome; patients with both VT and VF had the worst outcome; and among patients who survived hospitalization, the 1-year mortality rate was significantly higher in those who experienced VT alone or VT and VF. (Circulation. 1998;98:2567-2573.)
doi:10.1161/01.cir.98.23.2567 pmid:9843464 fatcat:6gj7k65fzbhfboj6jqbbrt3yry