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. 2012 Dec;1(4):302-11.
doi: 10.1177/2048872612463553.

Prognostic impact of early ventricular fibrillation in patients with ST-elevation myocardial infarction treated with primary PCI

Marina M Demidova  1 , J Gustav Smith, Carl-Johan Höijer, Fredrik Holmqvist, David Erlinge, Pyotr G Platonov
Affiliations

Prognostic impact of early ventricular fibrillation in patients with ST-elevation myocardial infarction treated with primary PCI

Marina M Demidova et al. Eur Heart J Acute Cardiovasc Care. 2012 Dec.

Abstract

Aims: Current guidelines do not advocate implantation of cardioverter-defibrillators (ICD) for survivors of ventricular fibrillation (VF) during the first 48 hours of ST-elevation myocardial infarction (STEMI). However, contemporary studies in a real-life setting with long-term follow-up are lacking. We assessed the prognostic impact of early VF in a non-selected population of STEMI patients treated with primary percutaneous coronary intervention (PCI).

Methods and results: Consecutive STEMI patients admitted to a Swedish tertiary care hospital during 2007-2009 were identified from the Register of Information and Knowledge about Swedish Heart Intensive Care Admissions (n=1718, age 66±12 years, 70% male). Patients with VF were identified from the register, and medical records were reviewed to determine the time point of VF. Patients surviving VF in the first 48 hours after symptom onset were compared with patients without VF for one-year mortality and a combined endpoint of death, resuscitated VF or appropriate ICD therapy. VF within 48 hours occurred in 7% of STEMI patients (n=121). In patients alive at 48 hours (n=1663), VF patients (n=101) had higher in-hospital mortality (12% vs. 2%, p<0.001). However, in VF patients discharged alive (n=89), mortality was low (1%) and combined endpoint rate (3%) did not differ compared with patients without VF (n=1538; 4% and 4% respectively).

Conclusion: In a large non-selected population of STEMI patients treated with primary PCI, VF during the first 48 hours after STEMI is associated with increased in-hospital mortality but does not influence the long-term prognosis for those discharged alive.

Keywords: Ventricular fibrillation; myocardial infarction; primary PCI; prognosis.

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Conflict of interest statement

Conflict of interest: None declared.

Figures

Figure 1.
Figure 1.
Timing of VT/VF during acute ST-elevation myocardial infarction (STEMI). PCI: percutaneous coronary intervention
Figure 2.
Figure 2.
Patient groups chart. VF: ventricular fibrillation; VT: ventricular tachycardiaI; ICD: implantation of cardioverter-defibrillator
Figure 3.
Figure 3.
(a) Kaplan–Meier survival analysis in regard to total mortality during follow-up for patients alive at 48 hours of STEMI. (b) Kaplan–Meier analysis in regard to combined endpoint of total mortality, appropriate ICD discharge or new VT/VF during follow-up for patients alive at 48 hours of STEMI. (c) Kaplan–Meier survival analysis in regard to total mortality during follow-up for patients discharged alive. (d) Kaplan–Meier analysis in regard to combined endpoint of total mortality, appropriate ICD discharge or new VT/VF during follow-up for patients discharged alive. STEMI: ST-elevation myocardial infarction; VT: ventricular tachycardia; VF: ventricular fibrillation; ICD: implantation of cardioverter-defibrillator
See this image and copyright information in PMC

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