Prognostic value of early sustained ventricular arrhythmias in ST-segment elevation myocardial infarction treated by primary percutaneous coronary intervention: A substudy of VALIDATE-SWEDEHEART trial
Research article published in Heart Rhythm O2 (2022)
Abstract
BACKGROUND: Prognostic assessment of ventricular tachycardia (VT) or ventricular fibrillation (VF) in ST-segment elevation myocardial infarction (STEMI) is based mainly on distinguishing between early (<48 hours) and late arrhythmias, and does not take into account its time distribution with regard to reperfusion, or type of arrhythmia. OBJECTIVE: We analyzed the prognostic value of early ventricular arrhythmias (VAs) in STEMI with regard to their type and timing. METHODS: The prespecified analysis of the multicenter prospective Bivalirudin versus Heparin in ST-Segment and Non-ST-Segment Elevation Myocardial Infarctionin Patients on Modern Antiplatelet Therapy in the Swedish Web System for Enhancement and Development of Evidence-based Care in Heart Disease evaluated according to Recommended Therapies Registry Trial included 2886 STEMI patients undergoing primary percutaneous coronary intervention (PCI). VA episodes were characterized regarding their type and timing. Survival status at 180 days was assessed through the population registry. RESULTS: Nonmonomorphic VT or VF was observed in 97 (3.4%) and monomorphic VT in 16 (0.5%) patients. Only 3 (2.7%) early VA episodes occurred after 24 hours from symptom onset. VA was associated with higher risk of death (hazard ratio 3.59; 95% confidence interval [CI] 2.01-6.42) after adjustment for age, sex, and STEMI localization. VA after PCI was associated with an increased mortality compared with VA before PCI (hazard ratio 6.68; 95% CI 2.90-15.41). Early VA was associated with in-hospital mortality (odds ratio 7.39; 95% CI 3.68-14.83) but not with long-term prognosis in patients discharged alive. The type of VA was not associated with mortality. CONCLUSION: VA after PCI was associated with an increased mortality compared with VA before PCI. Long-term prognosis did not differ between patients with monomorphic VT and nonmonomorphic VT or VF, but events were few. VA incidence during 24 to 48 hours of STEMI is negligibly low, thus precluding assessment of its prognostic importance.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Resumen
VALIDATE-SWEDEHEART substudy of 2886 STEMI patients; ventricular arrhythmia after PCI was associated with 6.68-fold higher mortality vs VA before PCI.
Por qué esto importa para la hirudoterapia
Este subestudio preespecificado del ensayo VALIDATE-SWEDEHEART analizó el valor pronóstico de las arritmias ventriculares tempranas en 2.886 pacientes con infarto de miocardio con elevación del segmento ST sometidos a ICP primaria, encontrando que las AV después de la ICP se asociaron con una mortalidad significativamente mayor que las AV antes de la ICP (HR 6,68), mientras que las AV tempranas se asociaron con mortalidad hospitalaria pero no con mortalidad a largo plazo en pacientes dados de alta vivos. El ensayo principal comparó bivalirudina versus heparina, que es el único vínculo tangencial con la familia de anticoagulantes derivados de la hirudina/sanguijuela. Para la ASH, la relevancia es mínima: se trata de un estudio de pronóstico de arritmias cardíacas sin ninguna intervención, resultado o hipótesis relacionada con sanguijuelas. ADVERTENCIA: Este estudio no involucra sanguijuelas, terapia con sanguijuelas ni secretoma de la sanguijuela; la conexión con la bivalirudina es incidental al análisis centrado en arritmias, y los hallazgos no tienen aplicación directa para la hirudoterapia.
Citación
Prognostic value of early sustained ventricular arrhythmias in ST-segment elevation myocardial infarction treated by primary percutaneous coronary intervention: A substudy of VALIDATE-SWEDEHEART trial.
Demidova MM et al. · Heart Rhythm O2, 2022
Contexto clínico relacionado
Explore cómo esta investigación se conecta con la práctica clínica
Añadido a la biblioteca ASH: May 27, 2026 · Última actualización del sitio: 18 de junio de 2026