TY - JOUR
T1 - Role of Ischemic Preconditioning and Inflammatory Response in the Development of Malignant Ventricular Arrhythmias After Reperfused ST-Elevation Myocardial Infarction
AU - Kaneko, Hidehiro
AU - Anzai, Toshihisa
AU - Naito, Kotaro
AU - Kohno, Takashi
AU - Maekawa, Yuichiro
AU - Takahashi, Toshiyuki
AU - Kawamura, Akio
AU - Yoshikawa, Tsutomu
AU - Ogawa, Satoshi
N1 - Funding Information:
Supported by the Global Center of Excellence (G-COE) Program at Keio University (H.K.) and the Medical School Faculty and Alumni Grant from Keio University Medical Science Fund (T.A.).
PY - 2009/11
Y1 - 2009/11
N2 - Background: Sustained ventricular tachycardia and ventricular fibrillation (VT/VF) are major complications of ST-elevation myocardial infarction (STEMI), even in the era of reperfusion therapy. We sought to clarify the determinants of VT/VF after reperfused STEMI. Methods and Results: Consecutive STEMI patients treated with primary percutaneous coronary intervention (n = 457) were divided into 2 groups by the presence or absence of VT/VF during hospitalization. Serum C-reactive protein (CRP) level and peripheral white blood cell (WBC) count were serially measured. VT/VF was observed in 54 patients (12%). Prior infarction was more common and preinfarction angina was less in patients with VT/VF than those without. Peak CRP level (P < .0001), WBC count on admission (P = .008), and maximum WBC count (P = .0014) were higher in patients with VT/VF than those without. VT/VF, especially VT/VF later than 48 hours after onset, was associated with greater left ventricular (LV) dimension during convalescence. Kaplan-Meier curves and log-rank test revealed VT/VF to be a significant determinant of long-term major adverse cardiac events. Multivariate analysis revealed that prior infarction, absence of preinfarction angina, and peak CRP ≥10 mg/dL were independent determinants of VT/VF. Conclusions: Lack of ischemic preconditioning, enhanced inflammatory response, and subsequent LV dysfunction are related to the development of VT/VF after STEMI.
AB - Background: Sustained ventricular tachycardia and ventricular fibrillation (VT/VF) are major complications of ST-elevation myocardial infarction (STEMI), even in the era of reperfusion therapy. We sought to clarify the determinants of VT/VF after reperfused STEMI. Methods and Results: Consecutive STEMI patients treated with primary percutaneous coronary intervention (n = 457) were divided into 2 groups by the presence or absence of VT/VF during hospitalization. Serum C-reactive protein (CRP) level and peripheral white blood cell (WBC) count were serially measured. VT/VF was observed in 54 patients (12%). Prior infarction was more common and preinfarction angina was less in patients with VT/VF than those without. Peak CRP level (P < .0001), WBC count on admission (P = .008), and maximum WBC count (P = .0014) were higher in patients with VT/VF than those without. VT/VF, especially VT/VF later than 48 hours after onset, was associated with greater left ventricular (LV) dimension during convalescence. Kaplan-Meier curves and log-rank test revealed VT/VF to be a significant determinant of long-term major adverse cardiac events. Multivariate analysis revealed that prior infarction, absence of preinfarction angina, and peak CRP ≥10 mg/dL were independent determinants of VT/VF. Conclusions: Lack of ischemic preconditioning, enhanced inflammatory response, and subsequent LV dysfunction are related to the development of VT/VF after STEMI.
KW - Ventricular arrhythmia
KW - ischemic preconditioning
KW - post-infarction inflammation
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U2 - 10.1016/j.cardfail.2009.05.001
DO - 10.1016/j.cardfail.2009.05.001
M3 - Article
C2 - 19879464
AN - SCOPUS:70350564900
SN - 1071-9164
VL - 15
SP - 775
EP - 781
JO - Journal of Cardiac Failure
JF - Journal of Cardiac Failure
IS - 9
ER -