Clin Res Cardiol (2023). https://doi.org/10.1007/s00392-023-02180-w

Ventricular arrhythmia without acute coronary syndrome as an indication for invasive coronary angiography

S. Kriechbaum1, S. Thomassek1, N. Osman2, J. S. Wolter1, M. Haas1, M. Weferling1, C. W. Hamm3, C. Liebetrau4, U. Fischer-Rasokat1

1Abteilung für Kardiologie, Kerckhoff Klinik GmbH, Bad Nauheim; 2Innere Medizin III, Krankenhaus der Barmherzigen Brüder Trier, Trier; 3Medizinische Klinik I - Kardiologie und Angiologie, Universitätsklinikum Gießen und Marburg GmbH, Gießen; 4Kardiologie, CCB am AGAPLESION BETHANIEN KRANKENHAUS, Frankfurt am Main;

Background: Ventricular arrhythmia in the clinical context of acute coronary syndrome is a validated indication for urgent invasive coronary angiography (ICA). In patients with ventricular arrhythmia but no acute coronary syndrome, the indication is less clear. The aim of this study was to determine the incidence of occlusive coronary artery disease (CAD) in these patients and to assess the association of arrhythmia subtypes and ICA findings to survival. Methods: This study analyzed patients who underwent ICA due to documented ventricular arrhythmia without an evidence of acute coronary syndrome between January 2004 and October 2017. Types of arrhythmia and findings from ICA were correlated to outcome. Results: Overall, 309 patients [240 male (78%) 69 female (22%), mean age 68.3 ± 10.5 y] with the evidence of ventricular arrhythmia were included. The following ventricular arrhythmia were detected: sustained ventricular tachycardia [VT; N= 140 (45.3%)], non-sustained ventricular tachycardia [nsVT; N= 97 (31.4%)], ventricular extrasystoles [VES; N= 72 (23.3%)]. A history of CAD was documented in 164 (53%) patients. The ICA detected a new CAD [N= 38 (12%)] or significant progression of known CAD [N= 72 (23%)] in 110 (36%) patients. Out of these patients 91 (83%) were treated with percutaneous coronary intervention (PCI), four (4%) were treated with coronary artery bypass grafting (CABG).  The other 199 (64%) patients showed no progression of a known CAD [N= 92 (30%)] or no CAD [N= 107 (34%)] without significant progression. During a median follow-up time of 42 months (IQR 18-60), 44 (14.2%) patients deceased. The subtype of ventricular arrhythmia was associated to prognosis (figure 1). In all subgroups (VT, nsVT, VES), the survival analysis revealed no difference between patients with new CAD or progression of CAD on the one hand and those without CAD or progression on the other (VT: p = 0.70; nsVT: p = 0.65; VES: p = 0.14). Furthermore in all subgroups (VT, nsVT, VES), the survival analysis found no difference between patients with a specific treatment of CAD (PCI or CABG) and those without (VT: p = 0.37; nsVT: p = 0.95; VES: p = 0.07). Conclusion: CAD is diagnosed in a relevant proportion of patients with ventricular arrhythmia but no evidence of an acute coronary syndrome. However, neither the successful detection of a new CAD or the progression of a known CAD nor the specific treatment (PCI or CABG) of a detected significant CAD had an impact on survival outcome.  This challenges ventricular arrhythmia as an indication for ICA.

https://dgk.org/kongress_programme/jt2023/aV700.html