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document
Sustained ventricular arrhythmias and mortality among patients with acute myocardial infarction : results from the GUSTO-III trial . BACKGROUND In many patients , ventricular arrhythmias will develop early after acute myocardial infarction . We studied the incidence , timing , and outcomes of such arrhythmias in the international Global Utilization of Streptokinase and TPA ( alteplase ) for Occluded Coronary Arteries ( GUSTO ) -III trial . METHODS We identified independent predictors of inhospital ventricular fibrillation ( VF ) and ventricular tachycardia ( VT ) and compared 30-day and 1-year mortality rates of patients who did ( n = 1121 ) and did not ( n = 13,921 ) have these arrhythmias during the index hospitalization . RESULTS Significant independent predictors of inhospital VF were higher Killip class , lower baseline systolic pressure , intravenous preenrollment lidocaine use , shorter time to thrombolysis , and beta-blocker use < 2 weeks before enrollment ; independent predictors of inhospital VT were lower baseline systolic pressure , intravenous lidocaine use before enrollment , higher Killip class , faster baseline heart rate , and advanced age . The 30-day mortality rate was 31 % in patients with VF , 24 % in those with VT , 44 % in those with both , and 6 % in those with neither ( P =.001 ) . The corresponding 1-year mortality rates were 34 % , 29 % , 49 % , and 9 % ( P =.001 ) . The 30-day and 1-year mortality rates were higher for patients with late ( > 48 hours after enrollment ) versus early arrhythmias ( < or =48 hours after enrollment ) . CONCLUSIONS Despite thrombolysis , inhospital ventricular arrhythmias are associated with higher 30-day and 1-year mortality rates after acute myocardial infarction , particularly when occurring later during the initial hospitalization . Better therapies are needed to improve outcomes of these arrhythmias .
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Intervention_Educational
We identified independent predictors of inhospital ventricular fibrillation ( VF ) and ventricular tachycardia ( VT ) and compared 30-day and 1-year mortality rates of patients who did ( n = 1121 ) and did not ( n = 13,921 ) have these arrhythmias during the index hospitalization .
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Intervention_Pharmacological
lidocaine use
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Outcome_Physical
Killip class
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Outcome_Physical
lower baseline systolic pressure
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Outcome_Other
intravenous preenrollment lidocaine use
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Outcome_Physical
thrombolysis
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Outcome_Physical
baseline systolic pressure
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Outcome_Physical
intravenous lidocaine
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Outcome_Physical
baseline heart rate
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Outcome_Mortality
30-day mortality rate
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Outcome_Mortality
1-year mortality rates
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Outcome_Mortality
30-day and 1-year mortality rates
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Outcome_Mortality
mortality rates
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Participant_Condition
patients with acute myocardial infarction
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Participant_Condition
acute myocardial infarction
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Participant_Condition
acute myocardial infarction