The association between early ventricular arrhythmias, renin-angiotensin-aldosterone system antagonism, and mortality in patients with ST-segment-elevation myocardial infarction: Insights from Global Use of Strategies to Open coronary arteries (GUSTO) V. American heart journal [Am Heart J] Journal article | | Title | The association between early ventricular arrhythmias, renin-angiotensin-aldosterone system antagonism, and mortality in patients with ST-segment-elevation myocardial infarction: Insights from Global Use of Strategies to Open coronary arteries (GUSTO) V. | | Author(s) | Askari AT, Shishehbor MH, Kaminski MA, Riley MJ, Hsu A, Lincoff AM, GUSTO-V Investigators | | Institution | Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA. arman.askari64@gmail.com | | Source | Am Heart J 2009 Aug; 158(2):238-43. | | MeSH | Aged
Angiotensin-Converting Enzyme Inhibitors
Antibodies, Monoclonal
Anticoagulants
Drug Therapy, Combination
Endpoint Determination
Female
Fibrinolytic Agents
Humans
Immunoglobulin Fab Fragments
Male
Middle Aged
Myocardial Infarction
Prognosis
Proportional Hazards Models
Receptors, Angiotensin
Recombinant Proteins
Risk Assessment
Tachycardia, Ventricular
Time Factors
Tissue Plasminogen Activator
Ventricular Fibrillation
| | Abstract | BACKGROUND: The long-term prognostic significance of early (<48 hours) ventricular fibrillation (VF) or sustained ventricular tachycardia (VT) in patients with an acute myocardial infarction remains controversial. Emerging data suggest that some of the benefit of renin-angiotensin-aldosterone system (RAAS) antagonism may be derived from a reduction in the incidence of these arrhythmias in the setting of acute myocardial infarction.
METHODS: We assessed the relationship between early VF/VT (defined as within 48 hours after admission) and mortality in 16,588 patients from global use of strategies to open coronary arteries (GUSTO) V trial. Furthermore, we examined the relationship between baseline use of angiotensin-converting enzyme inhibitor (ACEI)/angiotensin receptor blocker (ARB), early VF/VT, and mortality.
RESULTS: Early VF or VT occurred in 732 (4.4%) patients. Compared to patients without VF/VT, those experiencing early VF or VT had a significant increase in 30-day mortality (22% vs 5%, P < .001). Baseline use of an ACEI/ARB was associated with a decreased incidence of early VF/VT (odds ratio 0.65, 0.47-0.89, P = .008). A lower 30-day mortality was seen in patients with early VF/VT on baseline ACEI/ARB compared with patients with early VF/VT not receiving an ACEI/ARB at baseline (17.7% vs 24.2%, respectively, P = .04). The association between baseline RAAS antagonism and mortality persisted after adjustment for multiple confounders.
CONCLUSIONS: In patients presenting with acute myocardial infarction, early VF/VT identifies those at increased risk for 30-day mortality. Baseline use of RAAS antagonists is associated with a reduced incidence of malignant arrhythmias. Identifying how this association impacts short-term mortality in this patient population requires further prospective evaluation. | | Language | eng | | Pub Type(s) | Journal Article
Randomized Controlled Trial
| | PubMed ID | 19619700 |
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