Time Dependence of Ventricular Tachyarrhythmias After Myocardial Infarction: A MADIT-CRT Substudy

Mehmet F Ozlu; Alon Barsheshet; Arthur J Moss; Ilan Goldenberg; Valentina Kutyifa; Yitschak Biton; Scott McNitt; Wojciech Zareba; Mehmet K Aktas

doi:10.1016/j.jacep.2016.04.010

Time Dependence of Ventricular Tachyarrhythmias After Myocardial Infarction: A MADIT-CRT Substudy

JACC Clin Electrophysiol. 2016 Oct;2(5):565-573. doi: 10.1016/j.jacep.2016.04.010. Epub 2016 Jun 22.

Authors

Mehmet F Ozlu¹, Alon Barsheshet², Arthur J Moss³, Ilan Goldenberg³, Valentina Kutyifa³, Yitschak Biton³, Scott McNitt³, Wojciech Zareba³, Mehmet K Aktas⁴

Affiliations

¹ Abant Izzet Baysal University, Faculty of Medicine, Bolu, Turkey.
² Cardiology Department, Rabin Medical Center, Petah Tikva, and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
³ University of Rochester Medical Center, Rochester, New York, USA.
⁴ University of Rochester Medical Center, Rochester, New York, USA. Electronic address: Mehmet_Aktas@urmc.rochester.edu.

PMID: 29759576
DOI: 10.1016/j.jacep.2016.04.010

Abstract

Objectives: The purpose of this study was to assess the relationship between the time since a myocardial infarction (MI) and the risk of ventricular tachyarrhythmic events (VTEs) in patients with left ventricular dysfunction and mild symptoms of heart failure.

Background: Patients with left ventricular dysfunction after MI are at high risk for VTEs.

Methods: Ventricular tachycardia (VT), ventricular fibrillation (VF), or death as a function of time since MI was assessed in 693 patients enrolled in the MADIT-CRT (Multicenter Automatic Defibrillator Implantation Trial-Cardiac Resynchronization Therapy). Patients were categorized as those with a period of <3 years since an MI (lowest quartile, n = 172) versus those with a period of ≥3 years since an MI (n = 521). Risk of VT/VF or death was compared.

Results: Cumulative probability of VT/VF or death was significantly higher among patients in the highest quartile of time since an MI compared with those in the lowest quartile (41% vs. 22%, p = 0.015). Multivariate analysis showed that in patients with left bundle branch block (LBBB), those with a period of ≥3 years since an MI had a significantly higher risk of VT/VF or death (hazard ratio: 2.33; 95% confidence interval: 1.43 to 3.80; p = 0.001) and a higher risk of VT/VF (hazard ratio: 3.18; 95% confidence interval: 1.71 to 5.90; p < 0.001) compared with patients with a period of <3 years since an MI. These findings were consistent when the time since an MI was analyzed in a continuous fashion. A significant relationship between the time since an MI and outcomes was not observed in patients with non-LBBB.

Conclusions: Among post-MI patients with left ventricular dysfunction and LBBB, the risk of VTEs is directly related to the time since an MI occurred. (Multicenter Automatic Defibrillator Implantation Trial-Cardiac Resynchronization Therapy [MADIT-CRT]; NCT00180271).

Keywords: cardiac resynchronization therapy; implantable cardioverter-defibrillators; myocardial infarction; ventricular fibrillation; ventricular tachycardia.

Associated data

ClinicalTrials.gov/NCT00180271