JACC. Clinical electrophysiology · 2016
Time Dependence of Ventricular Tachyarrhythmias After Myocardial Infarction: A MADIT-CRT Substudy.
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Ozlu Mehmet F, Barsheshet Alon, Moss Arthur J, Goldenberg Ilan, Kutyifa Valentina, Biton Yitschak, McNitt Scott, Zareba Wojciech, Aktas Mehmet K
Аннотация
OBJECTIVES: The purpose of this study was to assess the relationship between the time since a myocardial infarction (MI) and the risk of ventricular tachyarrhythmic events (VTEs) in patients with left ventricular dysfunction and mild symptoms of heart failure.
BACKGROUND: Patients with left ventricular dysfunction after MI are at high risk for VTEs.
METHODS: Ventricular tachycardia (VT), ventricular fibrillation (VF), or death as a function of time since MI was assessed in 693 patients enrolled in the MADIT-CRT (Multicenter Automatic Defibrillator Implantation Trial-Cardiac Resynchronization Therapy). Patients were categorized as those with a period of <3 years since an MI (lowest quartile, n = 172) versus those with a period of ≥3 years since an MI (n = 521). Risk of VT/VF or death was compared.
RESULTS: Cumulative probability of VT/VF or death was significantly higher among patients in the highest quartile of time since an MI compared with those in the lowest quartile (41% vs. 22%, p = 0.015). Multivariate analysis showed that in patients with left bundle branch block (LBBB), those with a period of ≥3 years since an MI had a significantly higher risk of VT/VF or death (hazard ratio: 2.33; 95% confidence interval: 1.43 to 3.80; p = 0.001) and a higher risk of VT/VF (hazard ratio: 3.18; 95% confidence interval: 1.71 to 5.90; p < 0.001) compared with patients with a period of <3 years since an MI. These findings were consistent when the time since an MI was analyzed in a continuous fashion. A significant relationship between the time since an MI and outcomes was not observed in patients with non-LBBB.
CONCLUSIONS: Among post-MI patients with left ventricular dysfunction and LBBB, the risk of VTEs is directly related to the time since an MI occurred. (Multicenter Automatic Defibrillator Implantation Trial-Cardiac Resynchronization Therapy [MADIT-CRT]; NCT00180271).
BACKGROUND: Patients with left ventricular dysfunction after MI are at high risk for VTEs.
METHODS: Ventricular tachycardia (VT), ventricular fibrillation (VF), or death as a function of time since MI was assessed in 693 patients enrolled in the MADIT-CRT (Multicenter Automatic Defibrillator Implantation Trial-Cardiac Resynchronization Therapy). Patients were categorized as those with a period of <3 years since an MI (lowest quartile, n = 172) versus those with a period of ≥3 years since an MI (n = 521). Risk of VT/VF or death was compared.
RESULTS: Cumulative probability of VT/VF or death was significantly higher among patients in the highest quartile of time since an MI compared with those in the lowest quartile (41% vs. 22%, p = 0.015). Multivariate analysis showed that in patients with left bundle branch block (LBBB), those with a period of ≥3 years since an MI had a significantly higher risk of VT/VF or death (hazard ratio: 2.33; 95% confidence interval: 1.43 to 3.80; p = 0.001) and a higher risk of VT/VF (hazard ratio: 3.18; 95% confidence interval: 1.71 to 5.90; p < 0.001) compared with patients with a period of <3 years since an MI. These findings were consistent when the time since an MI was analyzed in a continuous fashion. A significant relationship between the time since an MI and outcomes was not observed in patients with non-LBBB.
CONCLUSIONS: Among post-MI patients with left ventricular dysfunction and LBBB, the risk of VTEs is directly related to the time since an MI occurred. (Multicenter Automatic Defibrillator Implantation Trial-Cardiac Resynchronization Therapy [MADIT-CRT]; NCT00180271).