Influence of standard modifiable risk factors on ventricular tachycardia after myocardial infarction

Tejas Deshmukh; Joshua G Kovoor; Karen Byth; Clara K Chow; Sarah Zaman; James J H Chong; Gemma A Figtree; Aravinda Thiagalingam; Pramesh Kovoor

doi:10.3389/fcvm.2023.1283382

Influence of standard modifiable risk factors on ventricular tachycardia after myocardial infarction

Front Cardiovasc Med. 2023 Oct 24:10:1283382. doi: 10.3389/fcvm.2023.1283382. eCollection 2023.

Authors

Tejas Deshmukh^{1

2}, Joshua G Kovoor³, Karen Byth⁴, Clara K Chow^{1

4}, Sarah Zaman^{1

4}, James J H Chong^{1

2}, Gemma A Figtree^{5

6}, Aravinda Thiagalingam^{1

4}, Pramesh Kovoor^{1

4}

Affiliations

¹ Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia.
² Centre for Heart Research, Westmead Institute for Medical Research, University of Sydney, Westmead, Sydney, NSW, Australia.
³ University of Adelaide, The Queen Elizabeth Hospital, Adelaide, SA, Australia.
⁴ Research and Education Network, Western Sydney Local Health District, Westmead Hospital, Sydney, NSW, Australia.
⁵ Kolling Institute, Royal North Shore Hospital, Sydney, NSW, Australia.
⁶ Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia.

Abstract

Background: Inducible ventricular tachycardia (VT) at electrophysiology study (EPS) predicts sudden cardiac death because of ventricular tachyarrhythmia, the single greatest cause of death within 2 years after myocardial infarction (MI).

Objectives: We aimed to assess the association between standard modifiable risk factors (SMuRFs) and inducible VT at EPS early after MI.

Methods: Consecutive patients with left ventricle ejection fraction ≤40% on days 3-5 after ST elevation MI (STEMI) who underwent EPS were prospectively recruited. Positive EPS was defined as induced sustained monomorphic VT cycle length ≥200 ms for ≥10 s or shorter if hemodynamically compromised. The primary outcome was inducibility of VT at EPS, and the secondary outcome was all-cause mortality on follow-up.

Results: In 410 eligible patients undergoing EPS soon (median of 9 days) after STEMI, 126 had inducible VT. Ex-smokers experienced an increased risk of inducible VT [multivariable logistic regression adjusted odds ratio (OR) 2.0, p = 0.033] compared with current or never-smokers, with comparable risk. The presence of any SMuRFs apart from being a current smoker conferred an increased risk of inducible VT (adjusted OR 1.9, p = 0.043). Neither the number of SMuRFs nor the presence of any SMuRFs was associated with mortality at a median follow-up of 5.4 years.

Conclusions: In patients with recent STEMI and impaired left ventricular function, the presence of any SMuRFs, apart from being a current smoker, conferred an increased risk of inducible VT at EPS. These results highlight the need to modify SMuRFs in this high-risk subset of patients.

Keywords: LVEF (left ventricular ejection fraction); electrophysiology study; myocardial infarction; standard modifiable risk factors; ventricular tachycardia.

Grants and funding

The authors declare financial support was received for the research, authorship, and/or publication of this article.