Temporal Trends in Prognosis of Patients with Acute Coronary Syndrome
Complicated by Ventricular Tachyarrhythmia
Abstract
Objectives: To evaluate clinical characteristics and prognosis of
patients presented with ventricular tachyarrhythmia (VTA) during the
course of acute coronary syndrome (ACS) and to analyze it according to
period of presentation. Background: VTA is an infrequent yet serious
complication of ACS. There is limited data regarding the incidence and
prognostic implications of VTA in the last decade as compared with the
previous decade. Methods: We evaluated clinical characteristics, major
adverse cardiovascular events, short and long- term mortality of
patients hospitalized with ACS who were enrolled in the Acute Coronary
Syndrome Israeli Survey (ACSIS) during the years 2000-2016. Patients
were classified into three groups: no VTA, early VTA (≤48h of onset) and
late VTA (>48h of onset). Data were analyzed according to
decades of presentation (current decade vs. previous decade). Results:
The study population comprised 15,200 patients. VTA occurred in 487
(3.2%) of patients. Early VTA presented in 373/487 (77%) patients and
late VTA in 114/487 (23%) patients. VTA’s, occurring in ACS patients
were associated with increased risk of in-hospital, 30-days, 1-year and
5-year mortality rates during both early and late periods in compared
with no VTA. Moreover, late VTA was associated with the highest
mortality rate with up to 65% in 5-year follow up (p<0.001).
Nevertheless, late VTA was associated with lower mortality rate in the
current decade (2008-2016) compared with last decade (2000-2006).
Conclusions: Any VTA following ACS was associated with high short and
long-term mortality rate. However, over the past decade there has been a
significant improvement in survival rates, especially in patients with
late VTA. This may be attributed to early and invasive reperfusion
therapy, implantable cardioverter defibrillator implantation and better
medical treatment.