Predicting Ventricular Arrhythmias and In-Hospital Mortality in Acute Coronary Syndrome Patients Presenting to the Emergency Department

Background: Ventricular arrhythmias (VA) after acute coronary syndrome (ACS) is associated with a higher risk of mortality. This study sought to examine the incidence, predictors and outcome of VA in ACS patients. Material and methods: A prospective cross-sectional study was conducted at the emergency department (ED), Universiti Kebangsaan Malaysia Medical Centre (UKMMC) in Kuala Lumpur, Malaysia. Patients with acute coronary syndrome (ST-segment elevation myocardial infarction [STEMI] and non-ST-segment elevation acute coronary syndrome [NSTEACS]) were continuously monitored for the occurrence of VA. Results: A total of 144 patients were recruited (67 STEMI and 77 NSTE-ACS). The total rate of VA was 18.8% (n = 27) and 14.6% (n = 21) experienced malignant ventricular arrhythmias (MVA) (8 ventricular fibrillation, 11 sustained ventricular tachycardia and 2 torsades de pointes). In-hospital mortality was reported in 11.1% of the subjects (n = 16). Factors predicted the occurrence of VA was Killip class IV (OR 8.67, 95% confidence interval [CI] 2.08-36.70, p < 0.05). Meanwhile, occurrence of MVA (OR 86.37, 95% CI 4.16 - 1792.70, p < 0.05) and blood sugar level (OR 1.30, 95% CI 1.01 - 1.67, p < 0.05) independently predicted in-hospital mortality. Conclusion: Incidence of VA was higher than the global estimate and the development of malignant forms of VA during hospitalization for ACS was associated with higher in-hospital mortalities.