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. 2022 Dec 14;43(47):4887-4896.
doi: 10.1093/eurheartj/ehac579.

Ventricular fibrillation in acute myocardial infarction: 20-year trends in the FAST-MI study

Rodrigue Garcia  1   2   3 , Eloi Marijon  1   4 , Nicole Karam  1   4 , Kumar Narayanan  4   5 , Frédéric Anselme  6 , Olivier Césari  7 , Laure Champ-Rigot  8 , Vladimir Manenti  9 , Raphael Martins  10 , Etienne Puymirat  1   4 , Jean Ferrières  11 , François Schiele  12 , Tabassome Simon  13 , Nicolas Danchin  1   4
Affiliations

Ventricular fibrillation in acute myocardial infarction: 20-year trends in the FAST-MI study

Rodrigue Garcia et al. Eur Heart J. .

Abstract

Aims: Sudden cardiac arrest remains a major complication of acute myocardial infarction (AMI) and is frequently related to ventricular fibrillation (VF). Incidence and impact of VF among patients hospitalized for AMI were evaluated.

Methods and results: Data from the FAST-MI programme consisting of 5 French nationwide prospective cohort studies between 1995 and 2015 were analysed, totally including 14 423 patients with AMI (66 ± 14 years, 72% males, 59% ST-elevation myocardial infarction). Overall, proportion of patients presenting in-hospital VF decreased from 3.9% in 1995 to 1.8% in 2015 (P < 0.001). One-year mortality decreased from 60.7% to 24.6% (P < 0.001). However, compared with patients who did not develop VF, the over-risk of 1-year mortality associated with VF was stable over time [hazard ratio (HR) 6.78, 95% confidence interval (CI) 5.03-9.14 in 1995 and HR 6.64, 95% CI 4.20-10.49 in 2015, P = 0.52]. This increased mortality in the VF group was mainly related to fatal events occurring prior to hospital discharge, representing 86.2% of 1-year mortality, despite the very low rate of implantable cardioverter defibrillator in the VF group (2.6%).

Conclusion: This study demonstrates that in-hospital VF incidence and mortality in the setting of AMI have significantly decreased over the past 20 years. Nevertheless, VF remained steadily associated with approximately a 10-fold increased relative risk of in-hospital mortality, without an impact on post-discharge mortality. Beyond long-term cardiac defibrillation strategy, these results emphasize the need to identify in-hospital interventions to further reduce mortality in VF patients.

Study registration: ClinicalTrials.gov Identifier: NCT00673036, NCT01237418, NCT02566200.

Keywords: Acute myocardial infarction; Implantable cardioverter defibrillator; Prognosis; Sudden death; Ventricular fibrillation.

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Conflict of interest statement

Conflict of interest: E.M. consultant for Medtronic, Boston Scientific, Abbott, and Zoll. Rodrigue Garcia has received grants from Medtronic, Boston Scientific, Mivroport, Abbott, consulting fees from Boston Scientific, Abbott, honoraria from Zoll, Abbott and support for attending meetings from Medtronic, Microport, Abbott, Boston Scientific, Biotronik, participated on a data safety monitoring board with Microport. Eloi Marijon has received grants from Boston Scientific, Medtronic, Zoll, Abbott, Microport, Biotronik, consulting fees from Medtronic, Abbott, Zoll, Boston Scientific. Nicole Karam has received consulting fees/honoraria from Abbott, Medtronic, Edwards, support for attending meetings from Abbott and Edwards. Laure Champ-Rigot has received consulting fees from Microport, honoraria from Boston Scientific, Medtronic and support for attending meetings from Boston Scientific. Jean Ferrières has received honoraria from Amgen, Sanofi, Servier. François Schiele has received grants from Amgen, Sanofi, Organon, Servier, Novonordisk and bayer, consulting fees from Servier, Novonordisk, Bayer and Sanofi, honoraria from Amgen, Sanofi, Servier, Recordati, Bayer, Organon and Mylan. Tabassome Simon has received grants from AstraZeneca, Bayer, Boehringer, Daiichi-Sankyo, Eli-Lilly, GSK, Sanofi, honoraria from Novartis and Servier and participated on a Data Safety Monitoring board with Ablative Solutions, Air Liquide, AstraZeneca, Sanofi, Novartis, 4Living Biotech. The other authors have nothing to declare.

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