Risk of death and recurrent ventricular arrhythmias in survivors of cardiac arrest concurrent with acute myocardial infarction.

Original Article Risk of Death and Recurrent Ventricular Arrhythmias in Survivors of Cardiac Arrest Concurrent With Acute Myocardial Infarction Ish Singla MD*, Haitham Hreybe MD*, Samir Saba MD Cardiovascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania * Authors contributed equally to this study Address for correspondence: Samir Saba, MD, Chief, Electrophysiology Section, 200 Lothrop Street, UPMC Presbyterian, Suite B-535, Pittsburgh, PA 15213-2582. E-mail: sabas/at/upmc.edu. There are no conflicts of interests to report for this work. Abstract Aims Cardiac arrest (CA) is an indication for defibrillator (ICD) implantation unless it occurs in the context of an acute myocardial infarction (AMI). We investigated the ventricular arrhythmia (VA)-free survival of patients resuscitated from CA in the setting of AMI. Methods We reviewed a database of 1600 AMI and CA survivors from which 48 patients were identified as having concurrent CA and AMI (CA+AMI group). Those patients were matched by age, gender, race, and left ventricular ejection fraction (LVEF) to 96 patients with AMI but no CA (AMI group) and 48 patients with CA but no AMI (CA group). Results Patients and controls were followed for 3.9±3.2 years. Patients in the 3 groups had similar baseline characteristics (age 63±14 yrs, 78% men, 98% white, 53% with CAD, LVEF 33±14%). The 5-year VA-free survival was 67%, 92%, and 80% for the CA+AMI, AMI, and CA groups, respectively, p<0.001. Conclusions Patients with concurrent CA and AMI are at high risk of recurrent VA, with VA-free survival rates significantly worse than those of patients with AMI but no CA, and comparable to those of patients with CA outside the context of an AMI. Accordingly, these patients should be considered for ICD implantation.