Prognostic value of non-sustained ventricular tachycardias after acute myocardial infarction in the thrombolytic era: importance of combination with frequent ventricular premature beats

Purpose: of this study was to re-evaluate the association between ventricular arrhythmias and long-term mortality after acute myocardial infarction (AMI) in the thrombolytic era. Methods: MITRA (maximal individual therapy in patients with AMI) is a multicenter registry of 54 hospitals in Germany investigating patients with AMI. Results: 2420 patients received Holter ECG. Positive Holter ECG was defined: ≥10ventricular premature beats (VPB)/h, or ≥4 couplets/d, or ≥1 non-sustained ventricular tachycardia (nsusVT)/d, or their combination. Mortality rates (median 17 months) were 6.5% without ventricular arrhythmias, with ≥10 VPB/h 15.2% and with the combination of ≥10VPB/h plus either ≥4 couplets/d or ≥1 nsusVT/d 23.4%. In multivariate analysis, none of the ventricular arrhythmias alone correlated with mortality. There was a significant association between mortality and the combination of ≥10 VPB/h plus ≥4 couplets/d (OR 2.3) or ≥10VPB/h plus ≥1 nsusVT/d (OR 2.8). Conclusion: Non-sustained VTs are only associated with poor prognosis if combined with frequent VPBs.