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CLINICAL RESEARCH: BETA-BLOCKERS IN MYOCARDIAL INFARCTION

Sustained ventricular tachycardia or fibrillation in the cardiac catheterization laboratory among patients receiving primary percutaneous coronary intervention

Incidence, predictors, and outcomes

Rajendra H. Mehta, MD, MS^*,*, Kishore J. Harjai, MD, Lorelei Grines, PhD, Gregg W. Stone, MD, Judy Boura, MS, David Cox, MD, William O'Neill, MD, Cindy L. Grines, MD Primary Angioplasty in Myocardial Infarction (PAMI) Investigators

^* University of Michigan, Ann Arbor, Michigan, USA
William Beaumont Hospital, Royal Oak, Michigan, USA
Lenox Hill Hospital, New York, New York, USA
Mid Carolina Cardiology, Charlotte, North Carolina, USA

Manuscript received June 17, 2003; revised manuscript received August 27, 2003, accepted September 8, 2003.

^* Reprint requests and correspondence: Dr. Cindy L. Grines, William Beaumont Hospital, 3601 West 13 Mile Road, Royal Oak, Michigan 48073, USA.
cgrines{at}beaumont.edu

OBJECTIVES: We sought to evaluate the incidence, predictors, and outcomes of ventricular tachycardia and/or ventricular fibrillation (VT/VF) in the cardiac catheterization laboratory among patients undergoing primary percutaneous coronary intervention (PCI).

BACKGROUND: Although VT/VF has been known to occur during primary PCI, the current data do not identify patients at risk for these arrhythmias or the outcomes of such patients.

METHODS: We evaluated 3,065 patients enrolled in the Primary Angioplasty in Myocardial Infarction (PAMI) trials, who underwent primary PCI to evaluate the associations of VT/VF and the influence of these arrhythmias on in-hospital and one-year outcomes.

RESULTS: In patients undergoing primary PCI, VT/VF occurred in 133 (4.3%). Multivariate analysis identified the following as independent correlates of VT/VF: smoking (odds ratio [OR] 1.95, 95% confidence interval [CI] 1.26 to 3.02), lack of preprocedural beta-blockers (OR 2.34, 95% CI 1.35 to 4.07), time from symptom onset to emergency room of 180 min (OR 2.63, 95% CI 1.42 to 4.89), initial Thrombolysis In Myocardial Infarction (TIMI) flow grade 0 (OR 2.06, 95% CI 1.23 to 3.47), and right coronary artery-related infarct (OR 1.93, 95% CI 1.25 to 2.99). Although patients with VT/VF had a higher incidence of bradyarrhythmias, hypotension, cardiopulmonary resuscitation, and endotracheal intubation in the catheterization laboratory, their in-hospital and one-year adverse outcomes were similar to those of the cohort without these arrhythmias.

CONCLUSIONS: Our findings suggest that the incidence of VT/VF during primary PCI is low, indicating that these arrhythmias do not influence PCI success or in-hospital or one-year outcomes. Our data further help identify patients at risk of VT/VF during primary PCI and suggest that pretreatment with beta-blockers should be strongly considered to reduce these arrhythmias.

Abbreviations and Acronyms   CI = confidence interval   ECG = electrocardiogram/electrocardiographic   OR = odds ratio   PAMI = Primary Angioplasty in Myocardial Infarction trial   PCI = percutaneous coronary intervention   RCA = right coronary artery   STEMI = ST-segment elevation myocardial infarction   TIMI = Thrombolysis In Myocardial Infarction   VF = ventricular fibrillation   VT = ventricular tachycardia

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