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(Circulation. 1998;98:2030-2036.)
© 1998 American Heart Association, Inc.
Clinical Investigation and Reports |
Nonsustained Ventricular Tachycardia in the Setting of Acute Myocardial Infarction
Tachycardia Characteristics and Their Prognostic Implications
From the Division of Cardiology, Department of Medicine, Northwestern University, Chicago, Ill.
Correspondence to Jeffrey Goldberger, MD, Northwestern Memorial Hospital, 250 E Superior St, Wesley Pavilion, Suite 520, Chicago, IL 60611. E-mail j-goldberger{at}nwu.edu
Background—Nonsustained ventricular tachycardia (NSVT) has significant prognostic implications in the setting of healing and healed myocardial infarction (MI), but only limited information is available on its importance in the setting of acute MI. We evaluated the prognostic significance of NSVT characteristics in the setting of acute MI.
Methods and Results—A prospective database was used to identify
112 patients with NSVT within 72 hours of acute MI. A control group was
identified matched for age, sex, type of MI, and
thrombolytic treatment. Mean age was 64 to 65 years in
the 2 groups with 71% to 72% men. Q-wave MI was noted in 52%
to 53%, and thrombolytic therapy was administered to
31% to 32% of patients in each group. In-hospital
ventricular fibrillation occurred more frequently in the
NSVT group (9% versus 0% in the control group;
P<0.001), but total in-hospital (10% versus 4%) and
follow-up mortality (10% versus 17%) did not differ between the 2
groups. With a Cox regression model, specific NSVT characteristics were
predictive of mortality. The strongest predictor was time from
presentation to occurrence of NSVT. Shortest RR interval
during NSVT was also a univariate predictor of mortality.
Multivariate analysis identified time from
presentation to occurrence of NSVT as the strongest
predictor of mortality (P<0.0001). The increased
relative risk of NSVT was first significant when it occurred 13 hours
from presentation and continued to increase as the time
from presentation to occurrence of NSVT increased,
plateauing at 
24 hours with a relative risk of 7.5.
Conclusions—Contrary to prevailing clinical opinion, NSVT that occurs in the setting of acute MI does have important prognostic significance. Specifically, the currently accepted notion that NSVT that occurs within 48 hours of acute MI has no prognostic significance needs to be adjusted. Although NSVT that occurs within the first several hours of presentation does not have an associated adverse prognosis, NSVT that occurs beyond the first several hours after presentation is associated with significant increases in relative risk.
Key Words: : myocardial infarction • tachycardia • risk factors • prognosis
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