Ventricular Arrhythmias and Hemodynamic Collapse During Acute Coronary Syndrome- Increased Risk for Sudden Cardiac Death?

Minna Järvensivu-Koivunen; Juho Tynkkynen; Niku Oksala; Markku Eskola; Jussi Hernesniemi

doi:10.1093/eurjpc/zwae074

Ventricular Arrhythmias and Hemodynamic Collapse During Acute Coronary Syndrome- Increased Risk for Sudden Cardiac Death?

Eur J Prev Cardiol. 2024 Feb 23:zwae074. doi: 10.1093/eurjpc/zwae074. Online ahead of print.

Authors

Minna Järvensivu-Koivunen¹, Juho Tynkkynen², Niku Oksala^{1

3

4}, Markku Eskola^{1

5}, Jussi Hernesniemi^{1

4

5}

Affiliations

¹ Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
² Department of Radiology, Tampere University Hospital, Tampere, Finland.
³ Vascular Centre, Tampere University Hospital, Tampere, Finland.
⁴ Finnish Cardiovascular Research Center Tampere.
⁵ Heart Hospital, Tampere University Hospital, Tampere, Finland.

PMID: 38394335
DOI: 10.1093/eurjpc/zwae074

Abstract

Aim: In acute phase of acute coronary syndrome (ACS), ventricular tachycardia (VT) and/or ventricular fibrillation (VF) leading to resuscitation are not considered to be associated with increased long-term sudden cardiac death (SCD) because the cause - acute ischemia - is believed to be reversible.Aim of this study was to investigate whether ventricular arrhythmias leading to sudden cardiac arrest during ACS associate with the risk of incident SCD in patients with normal or mildly impaired left ventricular ejection fraction (LVEF).

Methods: This study is based on a retrospective analysis of all 8,062 consecutive ACS patients undergoing coronary angiography with baseline LVEF ≥40% between 2007-2018 (follow-up until December 31st, 2021). The primary outcome was SCD equivalent life-threatening ventricular arrhythmias (LTVA) composing of true SCDs, aborted SCDs by successful resuscitation or appropriate ICD therapy. The risk of sudden LTVA was estimated with multivariate subdistribution hazard model using other deaths as competing events.

Results: Two-hundred and thirteen (n=211, 2.6%) patients suffered acute phase VF/VT leading to resuscitation and survived to discharge and most happened before angiography (80.6%, N=170) and were VF (92.9%, N=196). During a median follow-up of 7.6 years, 3.9% (N=316) of all the patients had LTVA (10.0% in VF/VT group vs 3.8% in other patients). VF/VTs during ACS associated with an increased risk for future SCD (HR 3.07; 95% CI 1.94-4.85, p<0.001). Most LTVAs occurred in patients without ICDs.

Conclusions: VF/VT in ACS associates with remarkably high long-term risk for SCD in patients with LVEF ≥40%.

Keywords: acute coronary syndrome; sudden cardiac death; ventricular tachyarrhythmias.

Plain language summary

This retrospective study comprising of over 8,000 patients without significant heart failure after acute coronary syndrome indicates that patients with potentially fatal ventricular arrhythmias during hospitalization for acute coronary syndrome are at 3-fold risk of sudden cardiac death or equivalent events in long-term when compared to those without ventricular arrhythmias Further study is required to confirm our findings and to assess whether electrophysiological examination or implantable cardioverter defibrillator therapy could be useful to prevent sudden cardiac death in these patients.