Prevalence and prognostic significance of ventricular arrhythmias after acute myocardial infarction in the fibrinolytic era. GISSI-2 results
Open accessAbstract
BACKGROUND: Several studies performed before the advent of thrombolysis have shown that the presence of ventricular arrhythmias is an independent risk factor for subsequent mortality in patients recovering from acute myocardial infarction. Since fibrinolysis affects the natural history of infarction and may alter the clinical relevance of different risk factors, the aim of the present study was to establish the prevalence and prognostic value of ventricular arrhythmias in post-myocardial infarction patients treated with fibrinolytic agents during the acute phase. METHODS AND RESULTS: Twenty-four-hour Holter recordings obtained before discharge from the hospital in 8,676 post-myocardial infarction patients of the GISSI-2 study were analyzed for the presence of ventricular arrhythmias. Patients were followed for 6 months from the acute event; total and sudden cardiovascular mortality rates were computed, and relative risks in univariate and multivariate analyses were calculated. Ventricular arrhythmias were present in 64.1% of the patients, more than 10 premature ventricular beats per hour were recorded in 19.7% of the patients, and nonsustained ventricular tachycardia was present in 6.8% of the patients. Ventricular arrhythmias were more frequent when signs or symptoms of left ventricular damage were present. During follow-up, there was a total of 256 deaths 2.0% in patients without ventricular arrhythmias, 2.7% in patients with one to 10 premature ventricular beats per hour, 5.5% in those with more than 10 premature ventricular beats per hour, and 4.8% in those with complex premature ventricular beats. Even after adjusting for several risk factors, the presence of frequent (more than 10 premature ventricular beats per hour) ventricular arrhythmias remained a significant predictor of total (RRCox, 1.62; 95% confidence interval, 1.16-2.26) and sudden mortality (RRCox, 2.24; 95% confidence interval, 1.22-4.08). On the other hand, the presence of nonsustained ventricular tachycardia was not associated with a worsening of the prognosis in the adjusted analysis (RRCox, 1.20; 95% confidence interval, 0.80-1.79). CONCLUSIONS: This study shows that approximately 36% of patients recovering from acute myocardial infarction presented with less than one premature ventricular beat per hour in Holter recordings obtained before discharge from the hospital, whereas almost 20% of patients showed frequent (more than 10 premature ventricular beats per hour) ventricular arrhythmias. Due to the large size of the population of this study, these figures may be used as a reliable estimate of the prevalence of arrhythmias in postinfarction patients treated with fibrinolytic agents during the acute phase. Frequent premature ventricular beats are confirmed as independent risk factors of total and sudden death in the first 6 months following the acute event; the significance of nonsustained ventricular tachycardia in this population appears more controversial.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
In the modern era, the independent predictive value of NSVT in MI survivors is not established.
“in the modern era, the independent predictive value of NSVT is not established”
From 2017 ISHNE-HRS expert consensus statement on ambulatory ECG and external cardiac monitoring/telemetry (2017) · cites this paper as Maggioni et al., 1993
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Part of this paper’s reference list could not be split into single entries.
Risk factors for sudden death after acute myocardial infarction: Two-year follow-up
Mukharji, J., Rude, R. E., Poole, W. K., Gustafson, N., Thomas, L. J., Strausś, H. W., Jaffe, A. S., Muller, J. E., Roberts, R., Raabe, D. S., et al. (1984) · The American Journal of Cardiology · doi:10.1016/0002-9149(84)90299-6 · Cited by 545 · see citing works
Bigger, J. T., Weld, F. M., & Rolnitzky, L. M. (1981) · The American Journal of Cardiology · doi:10.1016/0002-9149(81)90344-1 · Cited by 316 · see citing works
Ventricular premature complexes and sudden death after myocardial infarction.
Ruberman, W., Weinblatt, E., Goldberg, J. D., Frank, C. W., Chaudhary, B. S., & Shapiro, S. (1981) · Circulation · doi:10.1161/01.cir.64.2.297 · Cited by 312 · see citing works
Effect of thrombolysis on the evolution of late potentials within 10 days of infarction.
Eldar, M., Leor, J., Hod, H., Rotstein, Z., Truman, S., Kaplinsky, E., & Abboud, S. (1990) · Heart · doi:10.1136/hrt.63.5.273 · Cited by 61 · see citing works
Cats, V. M., Lie, K. I., van Capelle, F. J. L., et al. (1979) · The American Journal of Cardiology · doi:10.1016/0002-9149(79)90438-7 · Cited by 54 · see citing works
GISSI-2: mortality plus extensive left-ventricular damage as "end-point"
DEVITA, C. (1990) · The Lancet · doi:10.1016/0140-6736(90)90104-d · Cited by 21 · see citing works
White, H. D. (1990) · The American Journal of Cardiology · doi:10.1016/0002-9149(90)90742-j · Cited by 18 · see citing works
Meta-analysis of empirical long-term antiarrhythmic therapy after myocardial infarction
Hine, L. K. (1989) · JAMA · doi:10.1001/jama.262.21.3037 · Cited by 9 · see citing works
The effects of thrombolysis on risk stratification for arrhythmic events in post infarction patients
Farrell, T., Bashir, Y., Poloniecki, J., et al. (1991) · Journal of the American College of Cardiology · doi:10.1016/0735-1097(91)91033-b · Cited by 5 · see citing works
Flagged first, then by citations
Research works printed but not linked: 14
- [4]4. The Coronary Drug Project Research Group: Prognostic impor- tance of premature beats following myocardial infarction: Experi- ence in the coronary drug project. JAMA 1973;223:1116-1124
- [7]7. The Multicenter Postinfarction Research Group: Risk stratifica- tion and survival after myocardial infarction. N Engi J Med 1983; 309:331-336
- [8]8. Bigger JT, Fleiss JL, Kleiger R, Miller JP, Rolnitzky LM, and the Multicenter Postinfarction Research Group: The relationships among ventricular arrhythmias, left ventricular dysfunction, and mortality in the 2 years after myocardial infarction. Circulation 1984;69:250-258
- [10]10. Kostis JB, Byington R, Friedman LM, Goldstein S, Furberg C, for the BHAT Study Group: Prognostic significance of ventricular ectopic activity in survivors of acute myocardial infarction. J Am Coll Cardiol 1987;10:231-242
- [11]11. Furberg CD: Effect of antiarrhythmic drug on mortality after myo- cardial infarction. Am J Cardiol 1983;52:32C-36C
- [13]13. Echt DS, Liebson PR, Mitchell LB, et al: Mortality and morbid- ity in patients receiving encainide, flecainide, or placebo: The Cardiac Arrhythmia Suppression Trial. N Engi J Med 1991;324: 781-788
- [14]14. The Cardiac Arrhythmia Suppression Trial II Investigators: Effect of the antiarrhythmic agent moricizine on survival after myocardial infarction. N EngI J Med 1992;327:227-233
- [15]15. Gruppo Italiano per lo Studio della Streptochinasi nell'Infarto Miocardico (GISSI): Effectiveness of intravenous thrombolytic treatment in acute myocardial infarction. Lancet 1986;1:397-402
- [16]16. ISIS-2 (Second International Study of Infarct Survival) Collabora- tive Group: Randomised trial of intravenous streptokinase, oral aspirin, both, or neither among 17 187 cases of suspected acute myocardial infarction: ISIS-2. Lancet 1988;2:349-360
- [17]17. AIMS Trial Study Group: Long-term effects of intravenous anis- treplase in acute myocardial infarction: Final report of the AIMS study. Lancet 1990;335:427-431
- [18]18. Anglo-Scandinavian Study of Early Thrombolysis (ASSET): Trial of tissue plasminogen activator for mortality reduction in acute myocardial infarction. Lancet 1988;2:525-530
- [21]21. Volpi A, Cavalli A, Santoro E, Tognoni G, and GISSI Investiga- tors: Incidence and prognosis of secondary ventricular fibrillation in acute myocardial infarction: Evidence for a protective effect of thrombolytic therapy. Circulation 1990;82:1279-1288
- [23]23. Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto Miocardico: GISSI-2: A factorial randomised trial of alteplase versus streptokinase and heparin versus no heparin among 12 490 patients with acute myocardial infarction. Lancet 1990;336:65-71
- [26]26. Pratt CM, Hallstrom A, Theroux P, Romhilt D, Coromilas J, Myles J, for the CAPS Investigators: Avoiding interpretive pitfalls when assessing arrhythmia suppression after myocardial infarction: Insights from the long-term observations of the placebo-treated patients in the Cardiac Arrhythmia Pilot Study (CAPS). JAm Coll Cardiol 1991;17:1-8
Cited by
Sorted by citations
Priori, S. G., Blomström-Lundqvist, C., Mazzanti, A., Blom, N., Borggrefe, M., Camm, J., Elliott, P. M., Fitzsimons, D., Hatala, R., Hindricks, G., et al. (2015) · European Heart Journal · doi:10.1093/eurheartj/ehv316 · Cited by 3,893 · see citing works
Goldberger, J. J., Cain, M. E., Hohnloser, S. H., Kadish, A. H., Knight, B. P., Lauer, M. S., Maron, B. J., Page, R. L., Passman, R. S., Siscovick, D., et al. (2008) · Circulation · doi:10.1161/circulationaha.107.189375 · Cited by 1,450 · see citing works
La Rovere, M. T., Pinna, G. D., Hohnloser, S. H., Marcus, F. I., Mortara, A., Nohara, R., Bigger, J. T., Camm, A. J., & Schwartz, P. J. (2001) · Circulation · doi:10.1161/01.cir.103.16.2072 · Cited by 697 · see citing works
Steinberg, J. S., Varma, N., Cygankiewicz, I., Aziz, P., Balsam, P., Baranchuk, A., Cantillon, D. J., Dilaveris, P., Dubner, S. J., El-Sherif, N., et al. (2017) · Heart Rhythm · doi:10.1016/j.hrthm.2017.03.038 · Cited by 303 · see citing works
Bloch Thomsen, P. E., Jons, C., Raatikainen, M. J. P., Moerch Joergensen, R., Hartikainen, J., Virtanen, V., Boland, J., Anttonen, O., Gang, U. J., Hoest, N., et al. (2010) · Circulation · doi:10.1161/circulationaha.109.902148 · Cited by 285 · see citing works
Bhonsale, A., James, C. A., Tichnell, C., Murray, B., Gagarin, D., Philips, B., Dalal, D., Tedford, R., Russell, S. D., Abraham, T., et al. (2011) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2011.06.043 · Cited by 250 · see citing works
Mäkikallio, T. H., Barthel, P., Schneider, R., Bauer, A., Tapanainen, J. M., Tulppo, M. P., Schmidt, G., & Huikuri, H. V. (2005) · European Heart Journal · doi:10.1093/eurheartj/ehi188 · Cited by 249 · see citing works
Hohnloser, S. H., Klingenheben, T., Zabel, M., Schöpperl, M., & Mauß, O. (1999) · Journal of the American College of Cardiology · doi:10.1016/s0735-1097(99)00108-4 · Cited by 125 · see citing works
Scirica, B. M., Braunwald, E., Belardinelli, L., Hedgepeth, C. M., Spinar, J., Wang, W., Qin, J., Karwatowska-Prokopczuk, E., Verheugt, F. W. A., & Morrow, D. A. (2010) · Circulation · doi:10.1161/circulationaha.110.937136 · Cited by 123 · see citing works
QT Dynamicity and Sudden Death After Myocardial Infarction: Results of a Long‐Term Follow‐Up Study
CHEVALIER, P., BURRI, H., ADELEINE, P., KIRKORIAN, G., LOPEZ, M., LEIZOROVICZ, A., ANDRÉ‐FOUËT, X., CHAPON, P., RUBEL, P., & TOUBOUL, P. (2003) · Journal of Cardiovascular Electrophysiology · doi:10.1046/j.1540-8167.2003.02431.x · Cited by 94 · see citing works
Prognostic significance of ambulatory ECG monitoring for ventricular arrhythmias
Katritsis, D. G., Siontis, G. C. M., & Camm, A. J. (2013) · Progress in Cardiovascular Diseases · doi:10.1016/j.pcad.2013.07.005 · Cited by 44 · see citing works
- Authors
- Maggioni, A. P., Zuanetti, G., Franzosi, M. G., Rovelli, F., Santoro, E., Staszewsky, L., Tavazzi, L., & Tognoni, G.
- Affiliations
- GISSI-2 Coordinating Center, Milano, Italy.
- Mario Negri Institute for Pharmacological Research (IT)
- Venue
- Circulation
- Published
- 1993-02
- Volume
- 87
- Issue
- 2
- Pages
- 312-322
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- OpenAlex
- W2133434335
- Cited by
- 367
- References
- 9
- Citations by year
- 2026: 4 · 2025: 9 · 2024: 5 · 2023: 9 · 2022: 3 · 2021: 4 · 2020: 9 · 2019: 7 · 2018: 14 · 2017: 7 · 2016: 10 · 2015: 14 · 2014: 11 · 2013: 20 · 2012: 9
- FWCI
- 7.20
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Circulation (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Acute Myocardial Infarction Research
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
- Keywords
- ventricular arrhythmias, acute myocardial infarction, fibrinolysis, thrombolysis, premature ventricular contractions, non-sustained ventricular tachycardia, all-cause mortality, prognostic factors, left ventricular damage, Holter monitoring, risk stratification, left ventricular ejection fraction
- MeSH terms
- Adrenergic beta-Antagonists, Aged, Anti-Arrhythmia Agents, Arrhythmias, Cardiac, Female, Fibrinolytic Agents, Heart Ventricles, Humans, Male, Myocardial Infarction, Prognosis, Prevalence, Tachycardia, Ventricular
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
