CORRELATION BETWEEN CORONARY HEART DISEASE AND ISCHEMIC MALIGNANT ARRHYTHMIAS IN NSTEMI
Objective: setting in NSTEMI relationship between coronary stenosis and episodes of myocardial ischemia on ECG Holter associated with potentially malignant ventricular arrhythmias> Lown class IV and lower sinus rate variability.
Methods: 51 patients (P) consecutive NSTEMI (30M, 21 F), mean age (64 + / - 16 years) with NSTEMI and LVEF> 40%, 19 P diabetics (12M/7F) receiving standard that were performed during the first month coronaroangiography, 38 P (23M/15F) as stent, 4 (3M/1F) with aorto-coronary bypass. Holter ECG monitoring at 7 days and after 1 year.
Final point: cardiac mortality. Surrogate endpoints: rehospitalization for arrhythmia, recurrency of myocardial infarction.
Results: 2P (1M/1F) died in the hospital (3,92%). Other 5P (3M/2F) died after 1 year (9,81%). Unfavorable prognostic factors: number and position of proximal stenosis, ventricular extrasystole systematized> Lown class 4, HRV parameters decreased (LF < 16,2 ms HF<14,3 ms, SDNN <40,5 ms) and increased QT> 0,45 msec.
Conclusions: 1) small study, possibly irrelevant, 2) diabetes, beta blocker, age, bypass may influence HRV. 3) is required mandatory stenting / bypass significant stenosis (4) in case of low HVR and sustained VT at Holter ECG is recommended amiodarone, ICD.