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Cited by 42Cardiac Arrhythmias and TreatmentsCardiac electrophysiology and arrhythmiasCardiac pacing and defibrillation studies

Differences in inducibility and prognosis of in-hospital versus out-of-hospital identified nonsustained ventricular tachycardia in patients with coronary artery disease: Clinical and trial design implications

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Pires, Luis A, Lehmann, Michael H, Buxton, Alfred E, Hafley, Gail E, Lee, Kerry L·2001·Journal of the American College of Cardiology
DOI 10.1016/s0735-1097(01)01482-6
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Abstract

Objectives The goal of this study was to describe the influence of the clinical setting (in-hospital vs. out-of-hospital) in which nonsustained ventricular tachycardia (NSVT) is discovered on the rate of inducibility of sustained ventricular tachycardia (VT), arrhythmic events and survival in patients with coronary artery disease (CAD) and left ventricular (LV) dysfunction.Background In-hospital presentation of sustained VT is independently associated with lower long-term overall survival. The impact of the clinical setting in which NSVT is documented is unknown.Methods In the Multicenter Unsustained Tachycardia Trial (MUSTT), designed to assess the benefit of randomized antiarrhythmic therapy guided by electrophysiologic testing in patients with asymptomatic NSVT, CAD and LV dysfunction, eligible patients were enrolled irrespective of the setting in which the index arrhythmia was discovered. In this retrospective analysis, we compared the rate of VT inducibility and outcome of MUSTT-enrolled patients with in-hospital versus out-of-hospital presentation of NSVT.Results Monomorphic sustained VT was induced in 35% and 28% of the patients whose index NSVT occurred in-hospital and out-of-hospital, respectively (adjusted p = 0.006). Cardiac arrest or death due to arrhythmia at two- and five-year follow-ups were 14% and 28% for untreated patients with in-hospital-identified NSVT and 11% and 21% for the out-of-hospital group (adjusted p = 0.10). Overall mortality rates at two- and five-year follow-ups were 24% and 48% for inpatients and 18% and 38% for outpatients (adjusted p = 0.018). In patients randomized to antiarrhythmic therapy, there was no significant interaction between patient status (in-hospital vs. out-of-hospital) and treatment impact on the rates of total mortality (p = 0.98) and arrhythmic events (p = 0.08).Conclusions In patients with CAD and impaired LV function, asymptomatic NSVT identified in-hospital, compared with that identified out-of-hospital, is associated with a higher rate of induction of sustained VT and overall mortality. Therefore, in similar patients, the clinical setting in which NSVT is discovered should be taken into account when formulating patient risk, treatment and clinical trial design.

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  • In the late (>24 hr) post-acute MI inpatient period, detection of NSVT episodes has been associated with a higher rate of sustained VT and subsequent increased mortality.

    “In the late (.24 hr) postacute MI inpatient period, the detection of NSVT episodes has been associated with a higher rate of sustained VT and with subsequent increased mortality”

    From 2017 ISHNE-HRS expert consensus statement on ambulatory ECG and external cardiac monitoring/telemetry (2017) · cites this paper as Pires et al., 2001

    The Results and Discussion report that, among patients with coronary artery disease and impaired left ventricular function, in-hospital identification of NSVT was associated with greater inducibility of sustained VT and higher overall mortality than out-of-hospital identification. The paper does not establish this specifically for the >24-hour post-acute-MI inpatient period, and the higher sustained-VT finding concerns VT induced during testing rather than a clearly higher rate of subsequent spontaneous sustained VT. (LLM, conf=0.88)

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Research works printed but not linked: 3

  1. Epstein AE, Powell J, Yao Q, et al. In-hospital versus out-of-hospital 1161 JACC Vol. 38, No. 4, 2001
  2. Pires et al. October 2001:1156-62 Clinical Setting of Nonsustained VT presentation of life-threatening ventricular arrhythmias predicts survival: results from the AVID registry. J Am Coll Cardiol 1999;34:1111-6.
  3. Pinski SL, Yao Q, Epstein AE, et al. Determinants of outcome in patients with sustained ventricular tachyarrhythmias: the Antiarrhyth- mics Versus Defibrillator study registry. Am Heart J 2000;139:804 -13.

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Authors
Pires, L. A., Lehmann, M. H., Buxton, A. E., Hafley, G. E., & Lee, K. L.
Affiliations
  • University of Michigan (US)
  • Brown University (US)
  • Duke University (US)
ORCID
Venue
Journal of the American College of Cardiology
Publisher
Elsevier BV
Published
2001-10
Volume
38
Issue
4
Pages
1156-1162
ISSN
0735-1097 (ISSN-L)
DOI
10.1016/s0735-1097(01)01482-6
OpenAlex
W2149842827
Cited by
42
References
21
Citations by year
2025: 1 · 2024: 1 · 2022: 1 · 2019: 1 · 2018: 1 · 2017: 4 · 2015: 1 · 2013: 2 · 2012: 4
FWCI
2.92
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of the American College of Cardiology (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • National Institutes of Health (5u01hl045726-06)
  • National Heart, Lung, and Blood Institute (UO1HL45700, UO1-HL45726, U01HL045700)
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac pacing and defibrillation studies
Keywords
non-sustained ventricular tachycardia, coronary artery disease, left ventricular dysfunction, antiarrhythmic therapy, arrhythmic mortality, electrophysiologic testing, cardiac arrest
MeSH terms
Aged, Anti-Arrhythmia Agents, Coronary Disease, Female, Hospitalization, Humans, Male, Middle Aged, Prognosis, Retrospective Studies, Comorbidity, Proportional Hazards Models, Randomized Controlled Trials as Topic, Tachycardia, Ventricular, Ventricular Dysfunction, Left, Risk Assessment

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