Prognosis following sustained ventricular tachycardia occurring early after myocardial infarction

Robert B. Kleiman, John Miller, Alfred E. Buxton, Mark E. Josephson, Francis E. Marchlinski

Research output: Contribution to journalArticle

25 Citations (Scopus)

Abstract

Eighty-seven patients with sustained ventricular tachycardia (VT) between 3 and 90 days after acute myocardial infarction (AMI) were evaluated to define factors associated with a high risk of arrhythmia recurrence or death. Most patients had poor left ventricular function (mean ejection fraction 29 ± 12%), multivessel coronary artery disease (71%) and inducible sustained VT with programmed stimulation (87%). During a mean followup of 26 months, 36 patients (41%) died and 21 patients had arrhythmia recurrence (with 19 sudden deaths). Factors independently associated With mortality included: (1) treatment before 1981 (p <0.01); (2) anterior AMI (p <0.05); (3) short time from AMI to first episode of VT (p <0.06); and (4) multivessel coronary artery disease (p <0.07). Factors independently associated with arrhythmia recurrence were: (1) medical treatment (as opposed to surgical) (p <0.01); (2) ≥3 episodes of spontaneous VT (p = 0.01); (3) multivessel coronary disease (p <0.05); and (4) anterior AMI (p <0.07). Medically and surgically treated patients did not differ significantly in overall survival (49 vs 61%, respectively), although short-term (6 month) surgical survival improved from 31% during the first half of the study to 96% in the latter half (p <0.01). For patients with sustained VT early after AMI the risk of death and arrhythmia recurrence can be assessed based on clinical and angiographic characteristics; in addition, surgical treatment is associated with a lower incidence of arrhythmia recurrence than medical treatment. Given the recent improvement in short-term surgical survival, surgery may be the preferred option for high risk patients with multivessel coronary disease and frequent episodes of VT.

Original languageEnglish (US)
Pages (from-to)528-533
Number of pages6
JournalThe American Journal of Cardiology
Volume62
Issue number9
DOIs
StatePublished - Sep 15 1988
Externally publishedYes

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Ventricular Tachycardia
Myocardial Infarction
Cardiac Arrhythmias
Recurrence
Coronary Disease
Survival
Coronary Artery Disease
Therapeutics
Sudden Death
Left Ventricular Function
Mortality
Incidence

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Prognosis following sustained ventricular tachycardia occurring early after myocardial infarction. / Kleiman, Robert B.; Miller, John; Buxton, Alfred E.; Josephson, Mark E.; Marchlinski, Francis E.

In: The American Journal of Cardiology, Vol. 62, No. 9, 15.09.1988, p. 528-533.

Research output: Contribution to journalArticle

Kleiman, Robert B. ; Miller, John ; Buxton, Alfred E. ; Josephson, Mark E. ; Marchlinski, Francis E. / Prognosis following sustained ventricular tachycardia occurring early after myocardial infarction. In: The American Journal of Cardiology. 1988 ; Vol. 62, No. 9. pp. 528-533.
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abstract = "Eighty-seven patients with sustained ventricular tachycardia (VT) between 3 and 90 days after acute myocardial infarction (AMI) were evaluated to define factors associated with a high risk of arrhythmia recurrence or death. Most patients had poor left ventricular function (mean ejection fraction 29 ± 12{\%}), multivessel coronary artery disease (71{\%}) and inducible sustained VT with programmed stimulation (87{\%}). During a mean followup of 26 months, 36 patients (41{\%}) died and 21 patients had arrhythmia recurrence (with 19 sudden deaths). Factors independently associated With mortality included: (1) treatment before 1981 (p <0.01); (2) anterior AMI (p <0.05); (3) short time from AMI to first episode of VT (p <0.06); and (4) multivessel coronary artery disease (p <0.07). Factors independently associated with arrhythmia recurrence were: (1) medical treatment (as opposed to surgical) (p <0.01); (2) ≥3 episodes of spontaneous VT (p = 0.01); (3) multivessel coronary disease (p <0.05); and (4) anterior AMI (p <0.07). Medically and surgically treated patients did not differ significantly in overall survival (49 vs 61{\%}, respectively), although short-term (6 month) surgical survival improved from 31{\%} during the first half of the study to 96{\%} in the latter half (p <0.01). For patients with sustained VT early after AMI the risk of death and arrhythmia recurrence can be assessed based on clinical and angiographic characteristics; in addition, surgical treatment is associated with a lower incidence of arrhythmia recurrence than medical treatment. Given the recent improvement in short-term surgical survival, surgery may be the preferred option for high risk patients with multivessel coronary disease and frequent episodes of VT.",
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