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(Circulation. 2002;106:309.)
© 2002 American Heart Association, Inc.

Clinical Investigation and Reports

Sustained Ventricular Arrhythmias Among Patients With Acute Coronary Syndromes With No ST-Segment Elevation

Incidence, Predictors, and Outcomes

Sana M. Al-Khatib, MD, MHS; Christopher B. Granger, MD; Yao Huang, MS; Kerry L. Lee, PhD; Robert M. Califf, MD; Maarten L. Simoons, MD; Paul W. Armstrong, MD; Frans Van de Werf, MD; Harvey D. White, DSc; R. John Simes, MD; David J. Moliterno, MD; Eric J. Topol, MD; Robert A. Harrington, MD

From the Duke Clinical Research Institute (S.M.A., C.B.G., Y.H., K.L.L., R.M.C., R.A.H.), Durham, NC; University of Rotterdam (M.L.S.), Rotterdam, the Netherlands; University of Alberta (P.W.A.), Alberta, Edmonton, Canada; Gasthuisberg University Hospital (F.V.d.W.), Leuven, Belgium; Green Lane Hospital (H.D.W.), Auckland, New Zealand; University of Sydney (R.J.S.), New South Wales, Australia; and the Cleveland Clinic Foundation (D.J.M., E.J.T), Cleveland, Ohio.

Correspondence to Sana M. Al-Khatib, MD, Duke Clinical Research Institute, PO Box 17969, Durham, NC 27715. E-mail alkha001{at}mc.duke.edu

Background— The prognosis of ventricular arrhythmias among patients with non–ST-elevation acute coronary syndromes is unknown. We studied the incidence, predictors, and outcomes of sustained ventricular arrhythmias in 4 large randomized trials of such patients.

Methods and Results— We pooled the datasets of the Global Use of Streptokinase and tPA for Occluded Arteries (GUSTO)-IIb, Platelet Glycoprotein IIb/IIIa in Unstable Angina: Receptor Suppression Using Integrilin Therapy (PURSUIT), Platelet IIb/IIIa Antagonism for the Reduction of Acute Coronary Syndrome Events in a Global Organization Network (PARAGON)-A, and PARAGON-B trials (n=26 416). We identified independent predictors of ventricular fibrillation (VF) and ventricular tachycardia (VT) and compared the 30-day and 6-month mortality rates of patients who did (n=552) and did not (n=25 864) develop these arrhythmias during the index hospitalization. Independent predictors of in-hospital VF included prior hypertension, chronic obstructive pulmonary disease, prior myocardial infarction, and ST-segment changes at presentation. Except for hypertension, these variables also independently predicted in-hospital VT. In Cox proportional-hazards modeling, in-hospital VF and VT were independently associated with 30-day mortality (hazard ratio [HR], 23.2 [95% CI, 18.1 to 29.8] for VF and HR, 7.6 [95% CI, 5.5 to 10.4] for VT) and 6-month mortality (HR, 14.8 [95% CI, 12.1 to 18.3] for VF and HR, 5.0 [95% CI, 3.8 to 6.5] for VT). These differences remained significant after excluding patients with heart failure or cardiogenic shock and those who died <24 hours after enrollment.

Conclusions— Despite the use of effective therapies for non–ST-elevation acute coronary syndromes, ventricular arrhythmias in this setting are associated with increased 30-day and 6-month mortality. More effective therapies are needed to improve the survival of patients with these arrhythmias.

Key Words: coronary disease • tachycardia • fibrillation • prognosis • mortality

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