The significance of early-onset malignant arrhythmias in STEMI patients treated with primary percutaneous coronary intervention and their relationship with biomarkers

Abstract

Background/Aim. Patients treated with primary percutaneous coronary intervention (pPCI) and survive ventricular tachycardia (VT) and ventricular fibrillation (VF) in the first 48 hrs of ST-elevation myocardial infarction (STEMI), in most investigations had similar outcome of long-term prognosis compared to those patients not having VT and VF during the first 48 hrs of STEMI. The aim of the study was to determine association of myocardial infarction marker creatine kinase-MB fraction (CK MB), heart failure marker - brain natriuretic peptide and systemic inflammation factor - C reactive protein (CRP) with early VT and VF onset, with regard to 6 months mortality in patients with STEMI. Methods. The study included consecutive patients with STEMI treated with primary PCI during a 10-year period. VF and sustained VT were detected out of hospital and during the first 48 hrs of hospitalization. Results. In this study 971 consecutive patients with STEMI treated with primary PCI. During the first 48 hours from admission 108 (11.1%) patients had life-threatened arrhythmia of which 75 (69.4%) patients had VF and (33 patients, 30.6%) had sustained VT, treated with DC shock and intravenous amiodarone. Intrahospital mortality was significantly higher in patient with VF/sVT at 48 hrs compared to patients without VF/VT - 14.8% vs. 5.7% (p = 0.001). Brain natriuretic peptide (BNP) level had higher accuracy in the prediction of 6-month death than maximum C-reactive protein (CRP) blood level in patients without VF/sVT at 48 hrs, however, in patients with early onset malignant arrhythmias BNP had lower accuracy for the prediction of 6-month death and CRP values had almost the same accuracy. Admission glycaemia had much modest predictive value in both groups of patients compare to BNP and CRP [0.705 (0.628-0.781], p < 0.001 and 0.662 (0.521-0.803), p = 0.046. Maximum CK-MB levels were not predictive for 6-months all-cause mortality in neither groups. Conclusion. Our study indicates that STEMI patients with early onset VT and VF treated with primary PCI with a high BNP level have a statistically significantly higher mortality rate compared to patients with a lower BNP level.