Association of vitamin D with infarction-related arrhythmia in patients with acute myocardial infarction

Infarction-related arrhythmia is major complication of acute myocardial infarction (AMI). Vitamin D deficiency has been reported to be related to various cardiovascular diseases. This study investigated the association of vitamin D with infarction-related arrhythmia in patients with AMI.

We prospectively analyzed clinical data from all consecutive AMI patients. Infarction-related arrhythmia was defined as ventricular arrhythmias [ventricular fibrillation (VF) and ventricular tachycardia (VT)] and atrial arrhythmias [atrial fibrillation (AF) and atrial tachycardia (AT)] documented in in-hospital continuous EKG monitoring for at least 48 hours after development of AMI. Vitamin D deficiency was defined as a 25(OH)D level less than 20 ng/mL.

A total of 203 patients [150 men (74%), mean age 66 ± 14 years) were included in this study. Among them, ST-segment elevation myocardial infarction (STEMI) was diagnosed in 97 (48%) patients and non-STEMI was diagnosed in 106 (52%) patients. Overall 108 infarction-related arrhythmias, including 14 VFs, 48 VTs (16 sustained, 71 non-sustained), 38 AFs, and 18 ATs, were observed in 108 (53%) patients. Patients with infarction-related arrhythmia were older (68.4 ± 12.4 vs. 63.2 ± 14.5 years, p = 0.006) and likely to have more STEMI (59 vs. 35%, p <0.001), cardiogenic shock (32 vs. 10%, p <0.001), cardiac arrest (17 vs. 0%, p <0.001), and baseline renal dysfunction (estimated glomerular filtration <60 mL/min, 44 vs. 24%, p = 0.004). Killip class of 2 or more (50 vs. 23%, p <0.001) and left ventricular systolic (LVEF <40%, 32 vs. 19%, p = 0.049) were also frequently observed in patients with infarction-related arrhythmia.

Patients with infarction-related arrhythmia had lower vitamin D (12.9 ± 5.3 vs. 17.7 ± 7.3 ng/mL, p <0.001). In multivariate logistic analysis, vitamin D deficiency (OR 2.79, 95% CI 1.27 - 6.15, p = 0.011) was a significant independent predictor of infarction-related arrhythmia with cardiogenic shock (OR 3.71, 95% CI 1.51 - 9.14, p = 0.004), multivessel disease (OR 2.45, 95% CI 1.20 - 5.01, p = 0.014), and STEMI (OR 2.27, 95% CI 1.17 - 4.41, p = 0.016).

Vitamin D deficiency is an important independent predictor of infarction-related arrhythmias in patients with AMI.