Assessment of the Influence of Coronary Artery Stenting on the Frequency and Severity of Ventricular Ectopic Activity in Patients with Prior Myocardial Infarction with Preserved and Mildly Reduced Left Ventricular Ejection Fraction
Abstract
Background: Ventricular ectopic activity (VEA) is a common complication in post-myocardial infarction (MI) patients and is associated with increased risk of sudden cardiac death (SCD). The effect of coronary revascularization by stenting on the burden and severity of VEA in patients with preserved and mildly reduced left ventricular ejection fraction (LVEF) remains insufficiently studied. Objective: To evaluate the influence of complete versus incomplete coronary revascularization on the frequency and severity of VEA in post-MI patients with preserved and mildly reduced LVEF. Methods: A total of 270 patients (age 38–75 years) with prior MI were enrolled and divided into three groups: complete revascularization (CR, n=115), incomplete revascularization (IR, n=94), and no revascularization (NR, n=61). All patients underwent baseline coronary angiography and 24-hour Holter ECG monitoring, which was repeated at 1-year follow-up. VEA was assessed by daily burden, Bigger’s criteria, and Lown-Wolf classification. Clinical outcomes, including arrhythmic and non-arrhythmic adverse events, were also recorded. Results: At baseline, VEA was detected in 74–85% of patients across groups, without significant differences. After 1 year, the CR group demonstrated a significant reduction in VEA burden (36% decrease, p=0.048), fewer patients with >10 ectopic beats/hour (26.5% vs. 35.4%, p<0.001), and lower incidence of non-sustained ventricular tachycardia (NSVT, p=0.018) compared with IR and NR groups. Favorable shifts in Lown-Wolf classes were also observed, with an increased proportion of patients without VEA. In contrast, IR and NR groups showed persistent or worsening VEA, including higher rates of frequent ectopy and NSVT. The NR group exhibited a significant 1.5-fold increase in daily ectopy burden (p=0.015). Conclusion: Complete coronary revascularization by stenting is associated with significant reduction in VEA frequency and severity in post-MI patients with preserved and mildly reduced LVEF. Incomplete or absent revascularization fails to provide such benefits and may be linked to progression of arrhythmogenic activity. Achieving complete revascularization should be considered an important strategy for arrhythmia prevention in this patient population.