Trends and In-Hospital Outcomes of Ventricular Tachycardia in Ischemic Versus Non-Ischemic Dilated Cardiomyopathy-An Insight From the Nationwide Readmissions Database (2016-2020).

BACKGROUND

Ventricular tachycardia (VT) is a major cause of morbidity and mortality in patients with structural heart disease, yet real-world comparisons between ischemic cardiomyopathy (ICM) and non-ischemic dilated cardiomyopathy (NIDCM) remain limited.

METHODS

The national readmission database (2016-2020) was used to identify hospitalizations for VT. Cohorts were stratified based on underlying cardiomyopathy. A Propensity Score Matching (PSM) model matched ICM to NIDCM patients. Pearson's x2 test was applied to PSM-matched cohorts to compare outcomes.

RESULTS

We identified 622,092 VT hospitalizations, of which 575,312 (92.4%) had ICM and 46,780 (7.5%) had NIDCM. Outcomes were compared using multivariable logistic regression and propensity score matching (25,919 matched pairs). Despite being younger, NIDCM patients had higher in-hospital mortality (10.4% vs. 9.6%, p < 0.001; aOR 1.08), stroke (1.7% vs. 1.2%, aOR1.42), acute heart failure (65% vs. 59%, aOR 1.36), acute kidney injury (46.1% vs. 41.7%, aOR1.35), endotracheal intubation (13.1% vs. 14.5%, aOR 1.06), ICD implantation (3.9% vs. 3.5%, aOR1.23), and VT ablation (1.0% vs. 0.5%, aOR1.76). Readmission rates were significantly higher in NIDCM at 30 days (10.4% vs. 8.7%, p = 0.019), 90 days (22.7% vs. 20.0%, p = 0.483), and 180 days (30.7% vs. 27.3%, p = 0.001). In contrast, ICM patients had higher rates of sudden cardiac arrest (10.6% vs. 5.9%, aOR0.55), major adverse cardiovascular events (78.9% vs. 52.2%, aOR0.24), cardiogenic shock (18.4% vs. 12.1%, aOR0.59), ECMO (0.9% vs. 0.4%, aOR0.48), and LVAD use (0.5% vs. 0.3%, aOR0.58). Mortality declined over time in ICM (8.5% in 2016 to 8.2% in 2020, p-trend = 0.006), but not in NIDCM.

CONCLUSION

These findings highlight distinct clinical profiles and emphasize the need for targeted management strategies for VT based on the cardiomyopathy subtype.