Prognostic significance of ventricular ectopic activity in survivors of acute myocardial infarction who receive propranolol.

ABSTRACT

Beta blockers are frequently prescribed for survivors of acute myocardial infarction (AMI). Although ventricular ectopic activity was found to be associated with mortality in several cohorts, there are no data on the relation of ventricular ectopic activity to mortality in patients with AMI who receive beta blockers. One thousand six hundred and fifty participants in the Beta-Blocker Heart Attack Trial who were randomized to receive propranolol (60 or 80 mg 3 times daily) had 24-hour ambulatory electrocardiography at baseline. By multivariate analysis considering 16 variables, ventricular ectopic activity was independently associated with sudden death (p = 0.02 to 0.001) and total mortality (p = 0.04 to 0.0001) for an average follow-up of 25 months. By univariate analysis, ventricular ectopic activity was associated with increased total mortality (odds ratios 2.13 to 3.54) and sudden death mortality (odds ratio 2.26 to 3.93). The association of ventricular ectopic activity with mortality was observed in both high- and low-risk patient subsets with odds ratios similar to the placebo group. Thus, treatment with propranolol does not alter the relation between ventricular ectopic activity and mortality.