Abstract 1656: Prognosis After Ventricular Fibrillation During First Myocardial Infarction
Introduction: Based on data from the thrombolysis era high mortality rates are ascribed to survivors of primary ventricular fibrillation, i.e. VF within the first 48 hours of acute myocardial infarction (AMI). However, current guidelines do not advice ICD implantation if left ventricular function recovers well. We present new data from a large dataset of primary VF survivors treated with percutaneous coronary intervention (PCI).
Methods: Multi-center case-control study with prospective follow-up. Consecutive patients with a first AMI and VF prior to PCI (cases, n=372) were compared with patients with a first AMI without VF (controls, n=305). Primary endpoint is survival > 30 days.
Results: Median follow up duration was 3.34 years for cases and 3.69 years for controls (p = 0.015). VF occurred at a mean of 65 minutes after onset of chest pain and occurred out of hospital in 42.3%, in the ambulance in 23.4% and after hospital admission in 32.7% of cases. Median time to PCI was 160 mins in cases vs 180 mins in controls. All cause mortality > 30 days was 5.9% for cases and 8.2% for controls. Cox regression analysis showed that survival was not influenced by VF. During follow-up 25 cases received an ICD against 3 in controls. Even if all ICD wearers were presumed dead, VF did not reach significance as a predictor for survival. Significant predictors for improved survival were: younger age (p=0.013) and time to PCI (p=0.027).
Conclusion: VF during AMI does not predict survival in those who survive the first month. These VF survivors have an excellent prognosis with or without an ICD. This study underlines that primary VF by itself does not constitute an indication for ICD implantation.