muhammad rehan khan, Syed Azhar Sherazi, Badshah Noor, Amjad Abrar


Background: The incidence of Non- St Elevation Myocardial Infarction NSTEMI is increasing. With the limited coronary care facilities, acute life-threatening arrhythmias is of major interest to guide the decision on the intensity of care at the time of admission. The objective of the study was to determine the frequency, time and outcome of ventricular arrhythmias in patients with NSTEMI during their hospital stay.
Material and Method: This descriptive cross-sectional study was done in Cardiac Care Unit (CCU) of District Headquarter Teaching Hospital, Dera Ismail Khan, Pakistan, from January 2, 2015 to October 10, 2015. Sample size was 450. Sampling technique was nonprobability, consecutive. Patients with NSTEMI admitted in CCU were included. Patients with STEMI were excluded from the study. After detailed history, clinical examination and baseline routine investigations, the patients were managed conservatively. Patients were monitored for malignant ventricular arrhythmia and ECG were done on routine basis to document VT/VF as long as patients remained in hospital. Collected data was analysed using SPSS version 10 software for descriptive analysis.
Result: Out of 450 patients, there were 260 (58%) males and 190 (42%) females with age ranging from 40 to 90 years and mean age of 60.47±9.7 years. Frequency of malignant ventricular arrhythmias was 22(5%). Out of 22 patients, malignant VT/VF occurred within 48 hours after enrollment in 15(68% ), while 7 patients (32%) had VT/ VF after 48 hours. Thirteen (59%) patients died due to ventricular arrhythmia.
Conclusions: Frequency of malignant ventricular arrhythmias and mortality among patients with NSTEMI was high especially in males, between 51 to 75 years. Malignant VT/VF commonly occurred within 48 hours after admission.


Mortality; Arrhythmia; Ventricular Tachycardia; Ventricular Fibrillation.

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Hasin Y, Danchin N, Filippatos GS, Heras M, Janssens U, Leor J, et al. Recommendations for the structure, organization, and operation of intensive cardiac care units. Eur Heart J 2005;26:1676–82.

Drew BJ, Califf RM, Funk M, Kaufman ES, Krucoff MW, Laks MM, et al. Practice Standards for electrocardiographic monitoring in hospital settings: an American Heart Association scientific statement from the Councils on Cardiovascular Nursing, Clinical Cardiology, and Cardiovascular Disease in the Young: endorsed by the International Society of Computerized Electrocardiology and the American Association of Critical-Care Nurses. Circulation 2004;110:2721–46.

Lloyd-Jones D, Adams RJ, Brown TM, Carnethon M, Dai S, De Simone G, et al. Heart disease and stroke statistics—2010 update: a report from the American Heart Association. Circulation 2010;121:e46-e215.

Yeh RW, Sidney S, Chandra M, Sorel M, Selby JV, Go AS. Population trends in the incidence and outcomes of acute myocardial infarction. N Engl J Med 2010;362:2155–65.

Al-Khatib SM, Stebbins AL, Califf RM, Lee KL, Granger CB, White HD, et al. Sustained ventricular arrhythmias and mortality among patients with acute myocardial infarction: results from the GUSTO-III trial. Am Heart J 2003; 145:515–21.

Mehta RH, Harjai KJ, Grines L, Stone GW, Boura J, Cox D, et al. Sustained ventricular tachycardia or fibrillation in the cardiac catheterization laboratory among patients receiving primary percutaneous coronary intervention: incidence, predictors, and outcomes. J Am Coll Cardiol 2004;43:1765–72.

Mehta RH, Starr AZ, Lopes RD, Hochman JS, Widimsky P, Pieper KS, et al. Incidence of and outcomes associated with ventricular tachycardia or fibrillation in patients undergoing primary percutaneous coronary intervention. JAMA 2009;301:1779 –89.

Piccini JP, Hranitzky PM, Kilaru R, Rouleau JL, White HD, Aylward PE, et al. Relation of mortality to failure to prescribe beta blockers acutely in patients with sustained ventricular tachycardia and ventricular fibrillation following acute myocardial infarction (from the VALsartan In Acutemyocardial iNfarcTion trial [VALIANT] Registry). Am J Cardiol 2008;102:1427–32.

Epstein AE, DiMarco JP, Ellenbogen KA, Estes NA, Freedman RA, Gettes LS, et al. ACC/AHA/ HRS 2008 guidelines for device-based therapy of cardiac rhythm abnormalities: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation 2008;117: 350–408.

Hohnloser SH, Kuck KH, Dorian P, Roberts RS, Hampton JR, Hatala R, et al. Prophylactic use of an implantable cardioverter-defibrillator after acute myocardial infarction. N Engl J Med 2004;351:2481–8.

Steinbeck G, Andresen D, Seidl K, Brachmann J, Hoffmann E, Wojciechowski D, et al. Defibrillator implantation early after myocardial infarction. N Engl J Med 2009;361:1427–36.

Zipes DP, Camm AJ, Borggrefe M, Buxton AE, Chaitman B, Fromer M, et al. ACC/AHA/ESC 2006 guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: a report of the American College of Cardiology/ American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines. Circulation 2006;114:385-484.

Al-Khatib SM, Stebbins AL, Califf RM, Lee KL, Granger CB, White HD, et al. Sustained ventricular arrhythmias and mortality among patients with acute myocardial infarction: results from the GUSTO-III trial. Am Heart J 2003; 145:515–21.

Winkler C, Funk M, Schindler DM, Hemsey JZ, Lampert R, Drew BJ. Arrhythmias in patients with acute coronary syndrome in the first 24 hours of hospitalization. Heart Lung 2013;42:422- 7.

Piccini JP, Berger JS, Brown DL. Early sustained ventricular arrhythmias complicating acute myocardial infarction. Am J Med. 2008;121:797– 804.

Giugliano RP, Newby LK, Harrington RA, Gibson CM, Van de Werf F, Armstrong P, et al. The Early Glycoprotein IIb/IIIa Inhibition in Non–ST-segment Elevation Acute Coronary Syndrome (EARLY ACS) trial: a randomized placebo-controlled trial evaluating the clinical benefits of early frontloaded eptifibatide in the treatment of patients with non–ST-segment elevation acute coronary syndrome: study design and rationale. Am Heart J 2005;149:994 –1002.

Scirica BM, Braunwald E, Belardinelli L, Hedgepeth CM, Spinar J, Wang W, et al. 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. Circulation 2010;122:455– 62.

Zorzi A, Turri R, Zilio F, Spadotto V, Baritussio A, Peruzza F, et al. At- admission risk stratification for in-hospital life-threatening ventricular arrhythmias and death in non-ST elevation myocardial infarction patients. Eur Heart J Acute Cardiovasc Care 2014;3:304-12.


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