Incidence of Cardiac Arrhythmias in Acute Myocardial Infarction Patients Undergoing Primary Percutaneous Coronary Intervention and Associated Outcomes During the First 24 Hours

Jehangir A Shah; Farah Naz; Rajesh Kumar; Muhammad Hassan; Ghazanfer Shah; Khalil Ahmed; Jamil Hussain; Khadijah Abid; Musa Karim

doi:10.7759/cureus.12599

Incidence of Cardiac Arrhythmias in Acute Myocardial Infarction Patients Undergoing Primary Percutaneous Coronary Intervention and Associated Outcomes During the First 24 Hours

Cureus. 2021 Jan 10;13(1):e12599. doi: 10.7759/cureus.12599.

Authors

Jehangir A Shah¹, Farah Naz¹, Rajesh Kumar¹, Muhammad Hassan¹, Ghazanfer Shah¹, Khalil Ahmed¹, Jamil Hussain¹, Khadijah Abid², Musa Karim³

Affiliations

¹ Adult Cardiology, National Institute of Cardiovascular Diseases, Karachi, PAK.
² Research Evaluation Unit, College of Physicians, Karachi, PAK.
³ Statistics, National Institute of Cardiovascular Diseases, Karachi, PAK.

Abstract

Background Acute myocardial infarction (AMI) is the most life-threatening manifestation of coronary artery diseases. The majority of deaths in AMI are due to arrhythmias. Therefore, the aim of this study was to evaluate the incidence and risk factors and outcomes of cardiac arrhythmias in AMI patients undergoing primary percutaneous coronary intervention (PCI) during the first 24 hours of the index hospitalization. Methodology This prospective observational study was conducted at the adult cardiology department of the National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan. Patients undergoing primary PCI were included in this study. All the patients were kept under observation for the first 24 hours of AMI and monitored through telemetry system monitoring and the incidence of cardiac arrhythmias and the outcomes were recorded. Results A total of 110 patients were included; the mean age was 59.6±13.1 years. Most of them were male (70.9%). Arrhythmias were observed in 89.1% of the patients, with 169 episodes. The accelerated idioventricular rhythm was the most common type of arrhythmia (37.3%) followed by sinus tachycardia (36.4%), ventricular tachycardia (22.7%), and complete heart block (20.0%). Lethal arrhythmias were observed in 64.5% (71) of the patients. During the hospital course, 65.5% developed arrhythmias during arrival to balloon time, 30% during the procedure, and 53.6% within 24 hours of the procedure. The in-hospital mortality rate was 15.5% with a significant association with the development of lethal arrhythmias within 24 hours of the procedure (21.1% vs. 5.1%; p=0.026). Conclusions The incidence of arrhythmias within 24 hours of hospitalization is high in patients with ST-elevation myocardial infarction (STEMI) undergoing primary PCI, and it has been observed to be associated with an increased rate of in-hospital mortality.

Keywords: acute myocardial infarction; cardiac arrhythmias; mortality; outcomes; primary percutaneous coronary intervention; risk factors.