Predicting survival with reperfusion arrhythmias during primary percutaneous coronary intervention for acute myocardial infarction

Background: The significance of arrhythmia occuring after successful recanalization of an occluded artery during treatment following primary percutaneous coronary intervention for ST-segment elevation myocardial infarction is controversial. Objectives: To study the association of reperfusion arrhythmia with short and long-term survival. Methods: We used a prospective registry of consecutive STEMI patients undergoing PPCI. Patients with an impaired epicardial flow (TIMI flow grade < 3) at the end of the procedure were excluded. Results: Of the 688 patients in the study group, 22% were women. Mean (+/- SD) age of the cohort was 61 (+/- 14) years and frequent co-morbidities included diabetes mellitus (25%), dyslipidemia (55%), hypertension (43%) and smoking (41%). RA was recorded in 200 patients (29%). Patients with RA had lower rates of diabetes (16% vs. 30%, P < 0.01) and hypertension (48% vs. 62%, P < 0.01), and a shorter median pain-to-balloon time (201 vs. 234 minutes, P < 0.01) than patients without RA. Thirty day mortality was 3.7% and 8.3% for patients with and without RA, respectively (P=0.04). After controlling for age, gender and pain-to-balloon time the hazard ratio for mortality for patients with RA during a median follow-up period of 466 days was 0.46 (95% confidence interval 0.23-0.92). Conclusions: The occurence of RA immediately following PPCI for acute STEMI is associated with better clinical characteristics and identifies a subgroup with a particularly favorable prognosis.