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Prognostic Significance of Ventricular Arrhythmias in 13 444 Patients With Acute Coronary Syndrome: A Retrospective Cohort Study Based on Routine Clinical Data (NIHR Health Informatics Collaborative VA-ACS Study)

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Arunashis Sau, Amit Kaura, Amar Ahmed, Kiran H.K. Patel, Xinyang Li, Abdulrahim Mulla, Benjamin Glampson, Vasileios Panoulas, Jim Davies, Kerrie Woods, Sanjay Gautama, Anoop D. Shah, Paul Elliott, Harry Hemingway, Bryan Williams, Folkert W. Asselbergs, Narbeh Melikian, Nicholas S. Peters, Ajay M. Shah, Divaka Perera & 5 more Rajesh Kharbanda, Riyaz S. Patel, Keith M. Channon, Jamil Mayet, Fu Siong Ng

Original languageEnglish
Article numbere024260
JournalJournal of the American Heart Association
Volume11
Issue number6
DOIs
Published15 Mar 2022

Bibliographical note

Funding Information: Dr Sau is supported by an NIHR Academic Clinical Fellowship (ACF-2019-21-001). Dr Ng and Dr Peters are supported by the British Heart Foundation (BHF; RG/16/3/32175 and PG/16/17/32069). Dr Kaura is funded by a BHF clinical research training fellowship (FS/20/18/34972). Dr Elliott and H. Hemingway received Health Data Research funding. Dr R.S. Patel is funded by a BHF intermediate fellowship (FS/14/76/30933). Dr A.D. Shah is funded by a THIS Institute postdoctoral fellowship. Dr A.M. Shah is funded by a BHF Professorship (CH/1999001/11735). Dr Mayet is supported by the BHF Imperial Centre for Research Excellence (RE/18/4/34215). Funding Information: This article reports independent research led and funded by the National Institute for Health Research (NIHR) Imperial Biomedical Research Centre (BRC), as part of the NIHR Health Informatics Collaborative with the NIHR Oxford BRC, the NIHR University College London Hospitals BRC, the NIHR Guy’s & St Thomas’ BRC and the NIHR Cambridge BRC. The views expressed in this publication are those of the authors and not necessarily those of the National Health Service, the NIHR or the Department of Health. This research was enabled by the Imperial Clinical Analytics Research and Evaluation (iCARE) environment and used the iCARE team and data resources (https://imperialbrc.nihr.ac.uk/facilities/icare/). Funding Information: This article reports independent research led and funded by the National Institute for Health Research (NIHR) Imperial Biomedical Research Centre (BRC), as part of the NIHR Health Informatics Collaborative with the NIHR Oxford BRC, the NIHR University College London Hospitals BRC, the NIHR Guy’s & St Thomas’ BRC and the NIHR Cambridge BRC. The views ex-pressed in this publication are those of the authors and not necessarily those of the National Health Service, the NIHR or the Department of Health. This research was enabled by the Imperial Clinical Analytics Research and Evaluation (iCARE) environment and used the iCARE team and data re-sources (https://imper​ialbrc.nihr.ac.uk/facil​ities/​icare/). Sources of Funding Dr Sau is supported by an NIHR Academic Clinical Fellowship (ACF-2019-21-001). Dr Ng and Dr Peters are supported by the British Heart Foundation (BHF; RG/16/3/32175 and PG/16/17/32069). Dr Kaura is funded by a BHF clinical research training fellowship (FS/20/18/34972). Dr Elliott and H. Hemingway received Health Data Research funding. Dr R.S. Patel is funded by a BHF intermediate fellowship (FS/14/76/30933). Dr A.D. Shah is funded by a THIS Institute postdoctoral fellowship. Dr A.M. Shah is funded by a BHF Professorship (CH/1999001/11735). Dr Mayet is supported by the BHF Imperial Centre for Research Excellence (RE/18/4/34215). Publisher Copyright: © 2022 The Authors.

King's Authors

Abstract

BACKGROUND: A minority of acute coronary syndrome (ACS) cases are associated with ventricular arrhythmias (VA) and/or cardiac arrest (CA). We investigated the effect of VA/CA at the time of ACS on long-term outcomes. METHODS AND RESULTS: We analyzed routine clinical data from 5 National Health Service trusts in the United Kingdom, col-lected between 2010 and 2017 by the National Institute for Health Research Health Informatics Collaborative. A total of 13 444 patients with ACS, 376 (2.8%) of whom had concurrent VA, survived to hospital discharge and were followed up for a median of 3.42 years. Patients with VA or CA at index presentation had significantly increased risks of subsequent VA during follow-up (VA group: adjusted hazard ratio [HR], 4.15 [95% CI, 2.42–7.09]; CA group: adjusted HR, 2.60 [95% CI, 1.23– 5.48]). Patients who suffered a CA in the context of ACS and survived to discharge also had a 36% increase in long-term mortality (adjusted HR, 1.36 [95% CI, 1.04–1.78]), although the concurrent diagnosis of VA alone during ACS did not affect all-cause mortality (adjusted HR, 1.03 [95% CI, 0.80–1.33]). CONCLUSIONS: Patients who develop VA or CA during ACS who survive to discharge have increased risks of subsequent VA, whereas those who have CA during ACS also have an increase in long-term mortality. These individuals may represent a sub-group at greater risk of subsequent arrhythmic events as a result of intrinsically lower thresholds for developing VA.

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