Risk Factors of In-Hospital Lethal Arrhythmia Following Acute Myocardial Infarction in Patients Undergoing Primary Percutaneous Coronary Intervention　- Insight From the J-MINUET Study.

Background: Lethal arrhythmias including ventricular tachycardia and fibrillation (VT/VF) are common complications of acute myocardial infarction (AMI). Predictors of in-hospital VT/VF after AMI, however, have not been thoroughly investigated. In this study, we sought to elucidate the predictors of in-hospital VT/VF events after AMI in the Japanese registry of acute Myocardial INfarction diagnosed by Universal dEfiniTion (J-MINUET). Methods and Results: In-hospital VT/VF was defined as a hemodynamically unstable VT or VF in the first week of hospitalization, on which the patients were classified as the VT/VF group. Of the patients in the J-MINUET study, 3,175 were finally enrolled in this study. A total of 114 patients had VT/VF. On multivariate logistic analysis, maximum creatine kinase >3,000 IU/L (adjusted OR, 1.67; 95% CI: 1.085-2.572; P=0.02), Killip class III or IV (adjusted OR, 8.93; 95% CI: 5.668-14.082; P<0.0001), initial Thrombolysis in Myocardial Infarction (TIMI) flow grade 0 or 1 (adjusted OR, 1.67; 95% CI: 1.035-2.709; P=0.03), and concomitant chronic kidney disease (CKD; adjusted OR, 1.80; 95% CI: 1.105-2.938; P=0.02) were identified as independent predictors for in-hospital VT/VF. Conclusions: From the J-MINUET study, extensive myocardial damage, cardiogenic shock, lower grade initial TIMI flow on coronary angiography, and concomitant CKD were independent predictors of in-hospital VT/VF after AMI.