Does PCI reduce arrhythmias in STEMI compared to thrombolysis?
BACKGROUND. In STEMI, PCI reduces mortality compared to fibrinolysis. However, it remains uncertain whether PCI reduces the incidence of early postinfarct arrhythmias.
MATERIAL AND METHODS. The incidence of arrhythmias was compared in two groups of consecutive STEMI-patients. One group was treated with PCI in 2006-07, while a historic control group received thrombolysis in 1996-98. All patients underwent continuous ECG monitoring throughout their hospital admission.
RESULTS. Among 93 PCI-patients, 38% had arrhythmias compared to 53% of the thrombolysed 97 patients (p=0,001). 27% in the PCI-group were treated for arrhythmias vs 34% among the thrombolysed (n.s.). Significantly fewer PCI-treated patients had atrial fibrillation (5% vs 16%), AV-block II/III (0% vs 6%) and asystoli (0% vs 5%), but an increased frequency of ventricular tachycardia was recorded. (10% vs 5%). 41% of all arrhythmic and 67% of treated events occurred in the first hour after PCI, compared to respectively 23% and 28% in the trombolysed(p=0,000). Mortality was greater in the thrombolysed group (11% vs 2%, p=0,006), but patients were older, had had more risk factors and had larger emit ions of cardiac enzymes. Number of days spent in the CCU was less in the PCI-population (1,4±0,2days vs 2,6± 0,7days,p=0,001)
CONCLUSIONS. PCI-treatment seems to reduce early post-STEMI arrhythmias, especially atrial fibrillation, AV-block grade II/ III and asystole. With PCI, the majority of arrhythmic events occurred in the first hour after revascularisation.