Ventricular arrhythmias and in-hospital outcomes in non-elective coronary artery bypass graft in type 1 myocardial infarction: An analysis of the national inpatient sample

Chanokporn Puchongmart; Varote Shotelersuk; Ben Thiravetyan; Panat Yanpiset; Thanaboon Yinadsawaphan; Narathorn Kulthamrongsri; Natnicha Leelaviwat; Zhaunn Sly

doi:10.12746/swjm.v14i60.1629

Chanokporn Puchongmart Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
Varote Shotelersuk Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
Ben Thiravetyan Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
Panat Yanpiset Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
Thanaboon Yinadsawaphan Department of Internal Medicine, John A Burns School of Medicine, Honolulu, HI, USA
Narathorn Kulthamrongsri Department of Internal Medicine, John A Burns School of Medicine, Honolulu, HI, USA
Natnicha Leelaviwat Division of Cardiology, Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
Zhaunn Sly Division of Cardiology, Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA

DOI: https://doi.org/10.12746/swjm.v14i60.1629

Abstract

Background: Malignant ventricular arrhythmias (VAs) are a serious complication of type 1 myocardial infarction (T1MI), yet their burden and impact on outcomes in patients undergoing urgent coronary artery bypass grafting (CABG) are not well established.

Objectives: We aim to identify the incidence and the prognostic impact of malignant VAs in patients undergoing non-elective CABG for T1MI.

Methods: A retrospective cohort study using the National Inpatient Sample from 2016 to 2022 was conducted by identifying all adult patients with T1MI who underwent non-elective CABG. Survey-weighted analyses were performed to compare baseline characteristics and outcomes between VAs and non-VAs groups. Multivariable logistic regression was used to evaluate the independent association between VAs and in-hospital mortality.

Results: Among 388,310 weighted hospitalizations for T1MI undergoing CABG, 10.0% had malignant VAs. Patients with VAs were younger (65.6 vs. 65.4 years, p < 0.01), less likely to be female (21.7% vs. 26.8%, p < 0.01), and had higher rates of comorbid conditions. The presence of VAs was associated with higher in-hospital mortality (11.2% vs. 2.7%), longer hospital stay (12 vs. 8 days), and increased incidence of acute kidney injury (40.9% vs. 27.8%, p < 0.01). After adjustment, VAs remained independently associated with increased odds of in-hospital mortality (aOR 2.90, 95% CI 2.62-3.21).

Conclusions: VAs occur around 10% in patients undergoing CABG for T1MI and are strongly associated with an increase in in-hospital mortality. These findings underscore the importance of perioperative monitoring and management of VAs in this high-risk population.

Keywords: Ventricular tachycardia, ventricular fibrillation, myocardial infarction, coronary artery bypass graft

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