Original Article

Correlations between Cardiovascular Risk Factors and Ventricular Arrhythmias Following Primary Percutaneous Coronary Intervention in Patients with ST-Elevation Myocardial Infarction


Background: Ventricular arrhythmias (VAs), which result from acute myocardial infarction and revascularization, are preventable causes of sudden cardiac death. This study aimed to determine the incidence, types, and risk factors of VAs in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention (PCI).

Methods: This cross-sectional study was conducted at the cardiology department of a tertiary care cardiac center in Zanjan, Iran. All the patients were monitored during hospitalization, and the incidence of cardiac arrhythmias and the outcomes were recorded.

Result: Among 315 patients, the mean age was 62.14±10.11 years, and 76.2% were male. Male gender was significantly associated with VA occurrence (P=0.038). Among the patients, 50.5% had VAs, of which 26.4% were sustained ventricular tachycardia (sustained VT) and ventricular fibrillation (VF). Sustained VT and VF, but not total arrhythmias, were more common in anterior infarctions. Most arrhythmias occurred during the first 12 hours, and frequent premature ventricular contractions (43.3%) and idioventricular rhythm (20.1%) were the most common. A history of PCI and coronary artery bypass grafting (CABG) was associated with substantially reduced arrhythmias (P=0.017 and P=0.013, respectively). However, cardiovascular risk factors exerted no statistically significant effects on the VA type.

Conclusion: Approximately half of our patients experienced reperfusion-induced VAs. Overall, gender and a history of PCI and CABG were significantly associated with VA occurrence. Therefore, males and patients without a positive history of PCI and CABG should receive antiarrhythmic drugs as a precaution.

1. Malakar AK, Choudhury D, Halder B, Paul P, Uddin A, Chakraborty S. A review on coronary artery disease, its risk factors, and therapeutics. J Cell Physiol 2019;234:16812-16823.
2. Hassanzadeh-Makoui R, Jamei M, Hassanzadeh-Makoui M, Khederlou H. Effects of Vitamin D on Left Ventricular Ejection Fraction in Patients with Systolic Heart Failure: A Double-Blind Randomized Clinical Trial. Int J Endocrinol Metab 2020;18:e103528.
3. Dalal J, Sahoo PK, Singh RK, Dhall A, Kapoor R, Krishnamurthy A, Shetty SR, Trivedi S, Kahali D, Shah B, Chockalingam K, Abdullakutty J, Shetty PK, Chopra A, Ray R, Desai D, Pachiyappan, Ratnaparkhi G, Sharma M, Sambasivam KA. Role of thrombolysis in reperfusion therapy for management of AMI: Indian scenario. Indian Heart J 2013;65:566-585.
4. Aslanabadi N, Safaie N, Talebi F, Dousti S, Entezari-Maleki T. The Streptokinase Therapy Complications and its Associated Risk Factors in Patients with Acute ST Elevation Myocardial Infarction. Iran J Pharm Res 2018;17(Suppl):53-63.
5. Ortega LM, Materson BJ. Hypertension in peritoneal dialysis patients: epidemiology, pathogenesis, and treatment. J Am Soc Hypertens 2011;5:128-136.
6. Podolecki TS, Lenarczyk RK, Kowalczyk JP, Jedrzejczyk-Patej EK, Chodor PK, Mazurek MH, Francuz PJ, Streb WA, Mitrega KA, Kalarus ZF. Risk stratification for complex ventricular arrhythmia complicating ST-segment elevation myocardial infarction. Coron Artery Dis 2018;29:681-686.
7. Kato M, Dote K, Sasaki S, Takemoto H, Habara S, Hasegawa D. Intracoronary verapamil rapidly terminates reperfusion tachyarrhythmias in acute myocardial infarction. Chest 2004;126:702-708.
8. Remmelink M, Delewi R, Yong ZY, Piek JJ, Baan J Jr. More pronounced diastolic left ventricular dysfunction in patients with accelerated idioventricular rhythm after reperfusion by primary percutaneous coronary intervention. J Invasive Cardiol 2010;22:574-578.
9. Qu Z, Weiss JN. Mechanisms of ventricular arrhythmias: from molecular fluctuations to electrical turbulence. Annu Rev Physiol 2015;77:29-55.
10. Escande W, Gourraud JB, Haissaguerre M, Gandjbakhch E, Lavergne T, Martins R, Cheniti G, Krisai P, Hermida JS, Maury P, Merino JL, Pasquié JL, Combes N, Surget E, Duchateau J, Pambrun T, Derval N, Hocini M, Jaïs P, Postema PG, Nademanee K, Vigmond E, Bernus O, Sacher F, Probst V. Malignant Purkinje ectopy induced by sodium channel blockers. Heart Rhythm 2022;19:1595-1603.
11. Jones DA, Rathod KS, Williamson A, Harrington D, Andiapen M, van Eijl S, Westwood M, Antoniou S, Schilling RJ, Ahluwalia A, Mathur A. The effect of intracoronary sodium nitrite on the burden of ventricular arrhythmias following primary percutaneous coronary intervention for acute myocardial infarction. Int J Cardiol 2018;266:1-6.
12. Larson J, Rich L, Deshmukh A, Judge EC, Liang JJ. Pharmacologic Management for Ventricular Arrhythmias: Overview of Anti-Arrhythmic Drugs. J Clin Med 2022;11:3233.
13. Rauniyar BK, Kadel A, Thakur K, Adhikari RB, Limbu D, Rajbhandari S, Kansakar S, Malla R, Adhikari CM, Maskey A, Rajbhandar R. Spectrum of coronary angiographic findings in patients with ST Elevation Myocardial Infarction (STEMI) undergoing primary PCI in a tertiary care center of Nepal. Ann Cardiol Angeiol (Paris) 2022;71:32-35.
14. Justin Paul G, Sankaran S, Saminathan K, Iliyas M, Sethupathy S, Saravanan S, Prabhu SS, Kurian S, Srinivas S, Anurag P, Srinivasan K, Manimegalai E, Nagarajan S, Ramesh R, Nageswaran PM, Sangareddi V, Govindarajulu R. Outcomes of ST Segment Elevation Myocardial Infarction without Standard Modifiable Cardiovascular Risk Factors - Newer Insights from a Prospective Registry in India. Glob Heart 2023;18:13.
15. Arnal JF, Valéra MC, Payrastre B, Lenfant F, Gourdy P. Structure-function relationship of estrogen receptors in cardiovascular pathophysiological models. Thromb Res 2012;130 Suppl 1:S7-11.
16. Willemars MMA, Nabben M, Verdonschot JAJ, Hoes MF. Evaluation of the Interaction of Sex Hormones and Cardiovascular Function and Health. Curr Heart Fail Rep 2022;19:200-212.
17. Vaura F, Palmu J, Aittokallio J, Kauko A, Niiranen T. Genetic, Molecular, and Cellular Determinants of Sex-Specific Cardiovascular Traits. Circ Res 2022;130:611-631.
18. Terkelsen CJ, Sørensen JT, Kaltoft AK, Nielsen SS, Thuesen L, Bøtker HE, Lassen JF. Prevalence and significance of accelerated idioventricular rhythm in patients with ST-elevation myocardial infarction treated with primary percutaneous coronary intervention. Am J Cardiol 2009;104:1641-1646.
19. Shah JA, Naz F, Kumar R, Hassan M, Shah G, Ahmed K, Hussain J, Abid K, Karim M. Incidence of Cardiac Arrhythmias in Acute Myocardial Infarction Patients Undergoing Primary Percutaneous Coronary Intervention and Associated Outcomes During the First 24 Hours. Cureus 2021;13:e12599.
20. Oikawa J, Fukaya H, Ako J, Nakao K, Ozaki Y, Kimura K, Noguchi T, Suwa S, Fujimoto K, Nakama Y, Morita T, Shimizu W, Saito Y, Hirohata A, Morita Y, Inoue T, Okamura A, Mano T, Miyamoto Y, Ogawa H, Ishihara M; on behalf the J-MINUET Investigators. Risk Factors of In-Hospital Lethal Arrhythmia Following Acute Myocardial Infarction in Patients Undergoing Primary Percutaneous Coronary Intervention-Insight From the J-MINUET Study. Circ Rep 2019;2:17-23.
21. Tatli E, Alicik G, Buturak A, Yilmaztepe M, Aktoz M. Arrhythmias following revascularization procedures in the course of acute myocardial infarction: are they indicators of reperfusion or ongoing ischemia? ScientificWorldJournal 2013;2013:160380.
22. Takada T, Shishido K, Hayashi T, Yokota S, Miyashita H, Yokoyama H, Nishimoto T, Ochiai T, Moriyama N, Tobita K, Mizuno S, Yamanaka F, Murakami M, Tanaka Y, Takahashi S, Saito S. Impact of Late Ventricular Arrhythmias on Cardiac Mortality in Patients with Acute Myocardial Infarction. J Interv Cardiol 2019;2019:5345178.
23. Huang J, Peng X, Fang Z, Hu X, Zhou S. Risk assessment model for predicting ventricular tachycardia or ventricular fibrillation in ST-segment elevation myocardial infarction patients who received primary percutaneous coronary intervention. Medicine (Baltimore) 2019;98:e14174.
24. Rathod KS, Jain AK, Firoozi S, Lim P, Boyle R, Nevett J, Dalby MC, Kalra S, Malik IS, Sirker A, Mathur A, Redwood S, MacCarthy PA, Wragg A, Jones DA. Outcome of inter-hospital transfer versus direct admission for primary percutaneous coronary intervention: An observational study of 25,315 patients with ST-elevation myocardial infarction from the London Heart Attack Group. Eur Heart J Acute Cardiovasc Care 2020;9:948-957.
25. Amon J, Wong GC, Lee T, Singer J, Cairns J, Shavadia JS, Granger C, Gin K, Wang TY, van Diepen S, Fordyce CB. Incidence and Predictors of Adverse Events Among Initially Stable ST-Elevation Myocardial Infarction Patients Following Primary Percutaneous Coronary Intervention. J Am Heart Assoc 2022;11:e025572.
26. Carrick D, Haig C, Carberry J, May VTY, McCartney P, Welsh P, Ahmed N, McEntegart M, Petrie MC, Eteiba H, Lindsay M, Hood S, Watkins S, Mahrous A, Rauhalammi SM, Mordi I, Ford I, Radjenovic A, Sattar N, Oldroyd KG, Berry C. Microvascular resistance of the culprit coronary artery in acute ST-elevation myocardial infarction. JCI Insight 2016;1:e85768.
27. Zhou P, Wu Y, Wang M, Zhao Y, Yu Y, Waresi M, Li H, Jin B, Luo X, Li J. Identifying the culprit artery via 12-lead electrocardiogram in inferior wall ST-segment elevation myocardial infarction: A meta-analysis. Ann Noninvasive Electrocardiol 2023;28:e13016.
28. Li Q, Wang DZ, Chen BX. Electrocardiogram in patients with acute inferior myocardial infarction due to occlusion of circumflex artery. Medicine (Baltimore) 2017;96:e6095.
29. Kazemisaeid A, Pakbaz M, Yaminisharif A, Davoodi G, Lotfi Tokaldany M, Hakki Kazazi E. Anatomy of Atrioventricular Node Artery and Pattern of Dominancy in Normal Coronary Subject: A Comparison between Individuals with and without Isolated Right Bundle Branch Block. J Tehran Heart Cent 2012;7:164-169.
30. al Awadhi AH, Ravindran J, Abraham KA, Graham IM. The prevalence and outcome of ventricular arrhythmias in acute myocardial infarction. Ir J Med Sci 1990;159:101-103.
31. Sattler SM, Skibsbye L, Linz D, Lubberding AF, Tfelt-Hansen J, Jespersen T. Ventricular Arrhythmias in First Acute Myocardial Infarction: Epidemiology, Mechanisms, and Interventions in Large Animal Models. Front Cardiovasc Med 2019;6:158.
IssueVol 18 No 2 (2023): J Teh Univ Heart Ctr QRcode
SectionOriginal Article(s)
DOI https://doi.org/10.18502/jthc.v18i2.13322
Cardiac arrhythmias Percutaneous coronary intervention Heart disease risk factors Outcome assessment ST-elevation myocardial infarction

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
Khederlou H, Azimi Pirsaraei SV, Rabbani E, Motedayen M. Correlations between Cardiovascular Risk Factors and Ventricular Arrhythmias Following Primary Percutaneous Coronary Intervention in Patients with ST-Elevation Myocardial Infarction. J Tehran Heart Cent. 2023;18(2):122-128.