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Cited by 123Acute Myocardial Infarction ResearchCardiac electrophysiology and arrhythmiasCardiac Arrhythmias and Treatments

Relationship Between Nonsustained Ventricular Tachycardia After Non–ST-Elevation Acute Coronary Syndrome and Sudden Cardiac Death: Observations From the Metabolic Efficiency With Ranolazine for Less Ischemia in Non–ST-Elevation Acute Coronary Syndrome–Thrombolysis in Myocardial Infarction 36 (MERLIN-TIMI 36) Randomized Controlled Trial

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Scirica, Benjamin M., Braunwald, Eugene, Belardinelli, Luiz, Hedgepeth, Chester M., Spinar, Jindrich, Wang, Whedy, Qin, Jie, Karwatowska-Prokopczuk, Ewa +2 more·2010·Circulation
DOI 10.1161/circulationaha.110.937136
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Abstract

Background— Most studies examining the relationship between ventricular tachycardia (VT) after acute coronary syndrome and sudden cardiac death (SCD) were performed before widespread use of reperfusion, revascularization, or contemporary medical therapy and were limited to ST-elevation myocardial infarction. The incidence and prognostic implications of VT in patients with non–ST-elevation acute coronary syndrome receiving contemporary care have not been examined. Methods and Results— The Metabolic Efficiency With Ranolazine for Less Ischemia in Non–ST-Elevation Acute Coronary Syndrome–Thrombolysis in Myocardial Infarction 36 (MERLIN-TIMI 36) trial randomized 6560 patients hospitalized with a non–ST-elevation acute coronary syndrome to ranolazine or placebo in addition to standard therapy. Continuous ECG recording was performed for the first 7 days after randomization and evaluated in a blinded core laboratory. SCD (n=121) was assessed over a median follow-up of 1 year. A total of 6345 patients (97%) had continuous ECG recordings evaluable for analysis. Compared with patients with no VT (n=2764), there was no increased risk of SCD in patients with only ventricular triplets (n=1978, 31.2%) (1.4% versus 1.2%); however, the risk of SCD was significantly greater in patients with VT lasting 4 to 7 beats (n=1172, 18.5%) (SCD, 2.9%; adjusted hazard ratio, 2.3; P <0.001) and in patients with VT lasting at least 8 beats (n=431, 6.8%) (SCD, 4.3%; adjusted hazard ratio, 2.8; P =0.001). This effect was independent of baseline characteristics and ejection fraction. VT occurring within the first 48 hours after admission was not associated with SCD. Conclusion— Nonsustained VT is common after admission for non–ST-elevation acute coronary syndrome, and even short episodes of VT lasting 4 to 7 beats are independently associated with the risk of SCD over the subsequent year. Clinical Trial Registration— URL: http://www.clinicaltrials.gov. Unique identifier: NCT00099788.

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  • Both short and longer NSVT episodes (4-7 or ≥8 beats) were significantly associated with 2.3- to 2.8-fold increased annual SCD risk, especially when associated with myocardial ischemia, irrespective of prior MI.

    “both short and longer NSVT episodes (4-7 or 8 beats) were significantly associated with 2.3-to 2.8-fold increased annual SCD risk, especially when associated with the presence of myocardial ischemia irrespective of the presence of prior myocardial infarction”

    From 2017 ISHNE-HRS expert consensus statement on ambulatory ECG and external cardiac monitoring/telemetry (2017) · cites this paper as Scirica et al., 2010

    The VT and SCD section reports significant adjusted hazard ratios of 2.3 for 4–7 beats and 2.8 for at least 8 beats over approximately one year; the subgroup analysis reports elevated risk with and without prior MI. Our copy does not show that the association was especially strong in the presence of myocardial ischemia. The Discussion also qualifies the longer-episode finding: episodes within 48 hours of admission were not associated with increased SCD risk. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • In patients with NSTE-ACS, the development of NSVT (≥3 beats, ≥100 bpm) beyond the first 48 hr after admission signifies increased mortality risk.

    “In patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS), the development of NSVT (3 beats, 100 bpm) beyond the first 48 hr after admission signifies the presence of increased mortality risk.”

    From 2017 ISHNE-HRS expert consensus statement on ambulatory ECG and external cardiac monitoring/telemetry (2017) · cites this paper as Scirica et al., 2010

    The Timing and Frequency of VT and Risk of SCD section (page unavailable) reports increased sudden cardiac death risk when VT lasting at least 8 beats occurred more than 48 hours after admission. The VT and SCD section (page unavailable) finds no significant increase for 3-beat episodes; increased risk begins at 4 beats. The cited result concerns sudden cardiac death, not mortality overall, so the claim’s ≥3-beat threshold and broader outcome overstate it. (LLM, conf=0.90)

    Experimental — accuracy not yet measured

  • Short-lasting NSVT episodes within the first 48 hr after admission did not carry the same risk, while similar episodes beyond 48 hr were associated with 2.9- to 3.7-fold annual SCD risk.

    “While short-lasting NSVT episodes occurring within the first 48 hr after admission did not carry the same risk, similar episodes that occurred beyond 48 hr were associated with significant (2.9-to 3.7-fold) annual SCD risk.”

    From 2017 ISHNE-HRS expert consensus statement on ambulatory ECG and external cardiac monitoring/telemetry (2017) · cites this paper as Scirica et al., 2010

    The Timing and Frequency of VT and Risk of SCD section (page unavailable) reports that episodes lasting at least 8 beats were not significantly associated with sudden cardiac death (SCD) when they occurred within 48 hours, but were associated with increased risk when they occurred later. It does not report a 2.9- to 3.7-fold risk specifically for episodes beyond 48 hours. The VT and SCD section gives 2.9% as a one-year SCD rate and 3.7 as the upper confidence limit of a hazard ratio for 4–7-beat episodes, not as the claimed fold-risk range. (LLM, conf=0.90)

    Experimental — accuracy not yet measured

  • In the MERLIN-TIMI 36 trial, continuous 7-day ECG monitoring recorded at least one episode of NSVT in more than half of NSTE-ACS patients.

    “Continuous 7-day ECG monitoring in NSTE-ACS patients in the Metabolic Efficiency with Ranolazine for Less Ischemia in Non-STelevation ACS-Thrombolysis In Myocardial Infarction (MERLIN-TIMI) 36 trial recorded at least one episode of NSVT in more than half of the patients in the overall cohort.”

    From 2017 ISHNE-HRS expert consensus statement on ambulatory ECG and external cardiac monitoring/telemetry (2017) · cites this paper as Scirica et al., 2010

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Authors
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.
Affiliations
  • Brigham and Women's Hospital (US)
  • From the TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital, and Harvard Medical School, Boston, Mass (B.M.S., E.B., C.M.H., J.Q., D.A.M.); Gilead Science, Inc, Palo Alto, Calif (L.B., W.W., E.K.-P.); University Hospital Brno, Brno, Czech Republic (J.S.); and Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands (F.W.A.V.).
ORCID
Venue
Circulation
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2010-08-03
Volume
122
Issue
5
Pages
455-462
ISSN
  • 0009-7322 (ISSN-L)
  • 1524-4539
DOI
10.1161/circulationaha.110.937136
OpenAlex
W2144924735
Cited by
123
References
32
Citations by year
2026: 1 · 2025: 4 · 2024: 4 · 2023: 7 · 2022: 7 · 2021: 3 · 2020: 6 · 2019: 4 · 2018: 10 · 2017: 15 · 2016: 7 · 2015: 3 · 2014: 10 · 2013: 7 · 2012: 11
FWCI
9.00
Type
journal article
Language
en
Open access
Locations
  • Circulation (publishedVersion)
  • PubMed (publishedVersion)
  • Radboud Repository (Radboud University) (submittedVersion)
Funders
  • AstraZeneca
  • Bayer
  • GlaxoSmithKline
  • Sanofi
  • Gilead Sciences
  • Johnson and Johnson
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 Arrhythmias and Treatments
Keywords
non-sustained ventricular tachycardia, non-ST-elevation acute coronary syndrome, sudden cardiac death, ranolazine, continuous ECG monitoring, prognostic risk
MeSH terms
Ranolazine, Acetanilides, Electrocardiography, Enzyme Inhibitors, Follow-Up Studies, Humans, Myocardial Infarction, Piperazines, Placebos, Prognosis, Risk Factors, Thrombolytic Therapy, Incidence, Proportional Hazards Models, Death, Sudden, Cardiac, Tachycardia, Ventricular, Ventricular Premature Complexes, Acute Coronary Syndrome

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