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| ===Cardiac Arrest or VT/VF Occurring As A Complication of STEMI===
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| * [[VT]]/[[VF]] and/or [[sudden death]] may occur early after the presentation of [[STEMI]] symptoms (<48 hours) and late after presentation (>48 hours)<ref name="pmid1951071">{{cite journal |author=Zehender M, Utzolino S, Furtwängler A, Kasper W, Meinertz T, Just H |title=Time course and interrelation of reperfusion-induced ST changes and ventricular arrhythmias in acute myocardial infarction |journal=Am. J. Cardiol. |volume=68 |issue=11 |pages=1138–42 |year=1991 |month=November |pmid=1951071 |doi= |url=}}</ref> <ref name="pmid1731450">{{cite journal |author=Gressin V, Louvard Y, Pezzano M, Lardoux H |title=Holter recording of ventricular arrhythmias during intravenous thrombolysis for acute myocardial infarction |journal=Am. J. Cardiol. |volume=69 |issue=3 |pages=152–9 |year=1992 |month=January |pmid=1731450 |doi= |url=}}</ref><ref name="pmid1883665">{{cite journal |author=Six AJ, Louwerenburg JH, Kingma JH, Robles de Medina EO, van Hemel NM |title=Predictive value of ventricular arrhythmias for patency of the infarct-related coronary artery after thrombolytic therapy |journal=Br Heart J |volume=66 |issue=2 |pages=143–6 |year=1991 |month=August |pmid=1883665 |pmc=1024606 |doi= |url=}}</ref><ref name="pmid3743145">{{cite journal |author=Buckingham TA, Devine JE, Redd RM, Kennedy HL |title=Reperfusion arrhythmias during coronary reperfusion therapy in man. Clinical and angiographic correlations |journal=Chest |volume=90 |issue=3 |pages=346–51 |year=1986 |month=September |pmid=3743145 |doi= |url=}}</ref><ref name="pmid8245327">{{cite journal |author=Berger PB, Ruocco NA, Ryan TJ, Frederick MM, Podrid PJ |title=Incidence and significance of ventricular tachycardia and fibrillation in the absence of hypotension or heart failure in acute myocardial infarction treated with recombinant tissue-type plasminogen activator: results from the Thrombolysis in Myocardial Infarction (TIMI) Phase II trial |journal=J. Am. Coll. Cardiol. |volume=22 |issue=7 |pages=1773–9 |year=1993 |month=December |pmid=8245327 |doi= |url=}}</ref><ref name="pmid9843464">{{cite journal |author=Newby KH, Thompson T, Stebbins A, Topol EJ, Califf RM, Natale A |title=Sustained ventricular arrhythmias in patients receiving thrombolytic therapy: incidence and outcomes. The GUSTO Investigators |journal=Circulation |volume=98 |issue=23 |pages=2567–73 |year=1998 |month=December |pmid=9843464 |doi= |url=}}</ref>.
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| * The occurrence of both early and late [[VT]]/[[VF]] is associated with higher mortality.
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| * In a large contemporary analysis which included 5,745 high-risk patients undergoing [[primary PCI]] in the APEX AMI trial, about 6% of patients developed [[VT]]/[[VF]].
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| *The majority of the cases (64%) occurred during [[cardiac catheterization]], and 90% of cases occurred within 48 hours of presentation of [[STEMI]] symptoms.
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| *90 day mortality was higher in those patients who sustained [[VT]]/[[VF]] (23.2% vs 3.6%, a multivariate hazard ratio of 3.63)<ref name="pmid19417195">{{cite journal |author=Mehta RH, Starr AZ, Lopes RD, Hochman JS, Widimsky P, Pieper KS, Armstrong PW, Granger CB |title=Incidence of and outcomes associated with ventricular tachycardia or fibrillation in patients undergoing primary percutaneous coronary intervention |journal=[[JAMA : the Journal of the American Medical Association]] |volume=301 |issue=17 |pages=1779–89 |year=2009 |month=May |pmid=19417195 |doi=10.1001/jama.2009.600 |url=http://jama.ama-assn.org/cgi/pmidlookup?view=long&pmid=19417195 |issn=}}</ref>.
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| * Mortality was higher among those patients with late [[VT]]/[[VF]] (33.3%) vs early [[VT]]/[[VF]] (17.2%).
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| * many of the subsequent deaths in patients with [[VT]]/[[VF]] was due to [[sudden cardiac death]], [[sudden cardiac death]] accounted for less than 50% of the mortality in [[VT]]/[[VF]] patients.
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| * VT/VF was not associated with one-year mortality in the [[Primary Angioplasty]] and [[Myocardial Infarction]] (PAMI) trials <ref>Mehta RH, Harjai KJ, Grines L, et al; Primary Angioplasty in Myocardial Infarction (PAMI) Investigators. Sustained ventricular tachycardia or fibrillation in the cardiac catheterization laboratory among patients receiving primary percutaneous coronary intervention: incidence, predictors, and outcomes. JAmColl Cardiol. 2004;43(10):1765-1772.</ref>,
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| *This is likely due to the fact that the PAMI population was of lower risk and had lower one-year mortality (4.5% in PAMI vs 23.2% reported in the present study).
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| ====Multivariate Predictors of Early [[VT]]/[[VF]] in the Setting of [[STEMI]]====
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| *Pre-PCI [[thrombolysis]] in [[MI]] (TIMI) flow grade 0
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| *[[Inferior myocardial infarction]]
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| *Total baseline [[ST deviation]]
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| *[[Creatinine]] clearance
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| *[[Killip class]] greater than I
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| *Baseline [[systolic blood pressure]]
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| *[[Body weight]]
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| *Baseline [[heart rate]] greater than 70/min
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| ====Multivariate Predictors of Late [[VT]]/[[VF]] in the setting of [[STEMI]]====
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| *[[Systolic blood pressure]]
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| *[[ST resolution]] less than 70%
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| *Baseline [[heart rate]] greater than 70/min
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| *Total baseline [[ST deviation]]
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| *[[Post-PCI TIMI flow]] less than grade 3
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| *[[Pre-PCI TIMI flow]] grade 0
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| *Blockers less than 24 hours
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| ====Clinical Implications====
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| Those patients with < [[TIMI]] grade 3 flow and < 70% ST resolution following PCI are at higher risk of [[VT]]/[[VF]] and should be monitored more carefully in an ICU or telemetry setting.
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| ===VT/VF Complicating AMI (both STEMI and NSTEMI taken together)===
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| While the prior information focuses on STEMI, a study by Piccini et al of 9,000 patients focused on both STEMI as well as NSTEMI who underwent PCI within 24 hours of acute MI in the New York State Coronary Angioplasty Reporting System database <ref>Piccini JP, Berger JS, Brown DL. Early sustained ventricular arrhythmias complicating acute myocardial infarction. Am J Med. 2008;121(9):797-804. </ref>. 5.2% of patients sustained VT/VF and mortality was over 4 times higher among patients with VT/VF (16.3% vs 3.7%). Operator reported successful PCI was associated with a lower subsequent mortality associated with VT/VF. The following were identified as independent predictors of early VT/VF:
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| #Cardiogenic shock (OR, 4.10; 95%CI, 3.20-5.58)
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| #Heart failure (OR, 2.86;95% CI, 2.24-3.67)
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| #Chronic kidney disease (OR, 2.58; 95% CI, 1.27-5.23)
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| #Early presentation (6 hours from symptom onset; OR, 1.46; 95% CI, 1.18-1.81)
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| The following variables were found to be independently associated with a lower risk of VT/VF:
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| #History of hypertension (OR, 0.81; 95% CI, 0.65-1.00)
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| #Lleft circumflex as infarct artery (OR, 0.80; 95% CI, 0.65-0.99)
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| #Diabetes mellitus (OR,0.57; 95% CI, 0.42-0.78)
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| #Higher left ventricular ejection fraction (every 5% increment; OR, 0.93; 95% CI, 0.91-0.96)
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| ==2013 Revised ACCF/AHA Guidelines for the Management of ST-Elevation Myocardial Infarction (DO NOT EDIT)<ref name="pmid23247303">{{cite journal |author=O'Gara PT, Kushner FG, Ascheim DD, ''et al.'' |title=2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction: Executive Summary: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines |journal=Circulation |volume= |issue= |pages=|year=2012 |month=December |pmid=23247303 |doi=10.1161/CIR.0b013e3182742c84|url=}}</ref>==
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| ===Assessment of Risk for Sudden Cardiac Death (DO NOT EDIT)<ref name="pmid23247303">{{cite journal |author=O'Gara PT, Kushner FG, Ascheim DD, ''et al.'' |title=2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction: Executive Summary: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines |journal=Circulation |volume= |issue= |pages= |year=2012 |month=December|pmid=23247303 |doi=10.1161/CIR.0b013e3182742c84|url=}}</ref>===
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| {|class="wikitable"
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| | colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
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| | bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' Patients with an initially reduced [[LV]] [[ejection fraction]] who are possible candidates for [[implantable cardioverter-defibrillator]] therapy should undergo reevaluation of LV ejection fraction 40 or more days after discharge.<ref name="pmid6708976">{{cite journal |author=Leppo JA, O'Brien J, Rothendler JA, Getchell JD, Lee VW |title=Dipyridamole-thallium-201 scintigraphy in the prediction of future cardiac events after acute myocardial infarction |journal=N. Engl. J. Med. |volume=310 |issue=16 |pages=1014–8 |year=1984 |month=April |pmid=6708976 |doi=10.1056/NEJM198404193101603 |url=}}</ref><ref name="pmid15590950">{{cite journal |author=Hohnloser SH, Kuck KH, Dorian P, ''et al.'' |title=Prophylactic use of an implantable cardioverter-defibrillator after acute myocardial infarction |journal=N. Engl. J. Med. |volume=351 |issue=24 |pages=2481–8 |year=2004 |month=December |pmid=15590950 |doi=10.1056/NEJMoa041489 |url=}}</ref><ref name="pmid18483207">{{cite journal |author=Epstein AE, DiMarco JP, Ellenbogen KA, ''et al.'' |title=ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices): developed in collaboration with the American Association for Thoracic Surgery and Society of Thoracic Surgeons |journal=Circulation |volume=117 |issue=21 |pages=e350–408 |year=2008 |month=May |pmid=18483207 |doi=10.1161/CIRCUALTIONAHA.108.189742 |url=}}</ref><ref name="pmid19812399">{{cite journal |author=Steinbeck G, Andresen D, Seidl K, ''et al.'' |title=Defibrillator implantation early after myocardial infarction |journal=N. Engl. J. Med. |volume=361 |issue=15 |pages=1427–36 |year=2009 |month=October |pmid=19812399 |doi=10.1056/NEJMoa0901889 |url=}}</ref>''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
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| ==References== | | ==References== |