European Heart Journal: Acute Cardiovascular Care最新文献

Background: Longer ischaemic time during ST-elevation myocardial infarction (STEMI) is associated with higher mortality. However, how prehospital delay time affects outcomes and has evolved over time remains unknown. The aims were to study prognostic impact of prehospital delay time in STEMI patients during two decades in Sweden, and to explore temporal trends and differences stratified by age, sex and presence of diabetes mellitus.

Methods: Observational prospective cohort study based on the SWEDEHEART registry 1998-2017. Associations between prehospital delay time and 14-day, 1-year and 5-year mortality were estimated with Kaplan Meier and Cox regression analyses.

Results: Among 89155 patients higher short- and long-term mortality was observed with increasing prehospital delay time. The multivariable adjusted risk of 14-days mortality increased approximately 2% per hour of delay (hazard ratio [HR] 1.018, 95% confidence interval [CI] 1.011-1.025), whereas the corresponding number for 1- and 5 year-mortality was 1% (HR 1.011, 95% CI 1.006-1.016 and HR 1.009, 95% CI 1.005-1.013, respectively). No significant trend of prehospital delay time during the 20 years was observed (median 150 minutes, interquartile range [IQR] 80-302), as the curve was hump-shaped. During the fibrinolytic era (1998-2004) prehospital delay time significantly increased while it decreased during the primary percutaneous coronary intervention (PPCI) era (2005-2017). Consistently prolonged prehospital delay times were shown in women, elderly (>70 years), and patients with diabetes with a delay 25-30 minutes longer than their counterparts.

Conclusions: Pre-hospital delay is an independent predictor of mortality. Whereas no declining trend was observed the last 20 years it is reassuring that a decrease of delay was found during the PPCI era. Women, elderly, and individuals with diabetes had consistently prolonged delay times and needs to be targeted in future interventions.

Aims: Refractory ventricular tachycardia (VT) is a rare but lethal condition in the early phase of acute myocardial infarction (AMI). Its intracardiac mechanism and role of catheter ablation is under-determined. The current study aims to evaluate the feasibility and safety of catheter ablation for refractory ventricular tachycardia in early AMI.

Methods and results: Between 2022 and 2024, 12 835 consecutive patients with AMI were screened, and VT/ventricular fibrillation (VF) was developed in 261 (2.0%) patients; among them 51 (19.5%) were identified as refractory VT storm necessitating intensive intervention, and finally 19 patients received bailout ablation for incessant VT. Their clinical and electrophysiological characteristics and outcomes were collected and analysed. For these, 19 patients underwent rescue ablation, VT was developed at a median of 4 days after the onset of AMI and became incessant 2 days after the first VT occurrence, despite revascularization, anti-arrhythmic agents, sedation, and haemodynamic support. Through intracardiac mapping, VTs were all identified as scar-related reentry within the territory of the culprit artery. The endocardial mappable cycle length (CL) was 65.3 ± 7.6% to the total CL. Energy delivery at either component of critical isthmus from the endocardium successfully eliminated VT, and no foci trigger was observed after VT termination. Subsequent substrate modification was performed around the termination site. After the index procedure, recurrent sustained VT was documented in two, and one patient received repeated ablation. After a total of 20 procedures, VTs were all well subsided after the index procedure in all except for one patient who died of cerebral haemorrhage. The remaining patients were discharged alive. After a median of 18-month follow-up, one patient developed recurrent VF, and no sudden cardiac death occurred.

Conclusion: Scar-related reentry is responsible for refractory VT early after AMI, and ablation at critical isthmus is effective in VT suppression. Its indication and optimal timing of catheter ablation should be evaluated in prospective analysis.