Abstract 17909: Ventricular Fibrillation During First 48 Hours of ST-Elevation Myocardial Infarction Treated with Primary Angioplasty Increases In-Hospital Mortality but Does Not Affect One-Year Survival in Patients Discharged Alive
Background: ICD implantation is not advocated for survivors of ventricular fibrillation (VF) during first 48h of ST-elevation myocardial infarction (STEMI). However the guidelines are based mostly on the data obtained before primary percutaneous coronary interventions (PCI) had become a standard of care. Long-term follow-up studies in contemporary real-life STEMI population are lacking. Our aim was to assess the prognostic value of early VF in non-selected population of PCI-treated STEMI patients.
Methods: Consecutive patients admitted to a tertiary care hospital for primary PCI during 2007-2009 were identified using hospital registry (n=1740, age 66±12 years, 71% male). The registry data were used to find those who had VF documented during index admission and their medical records were scrutinized for VF timing in regard to the symptom onset. Information regarding ICD implants during follow-up was retrieved from the ICD registry and delivery of adequate ICD therapy was checked in medical records. Kaplan-Mayer analysis was performed on patients alive at 48 hours after symptom onset using death at 1 year as a primary endpoint. Death, resuscitated VF or adequate ICD therapy was used as a combined endpoint.
Results: Early VF occurred in 7% of STEMI patients (n=124, age 67±12, 73% male, VF group). In patients alive at 48h (n=1684), VF patients (n=103) had higher in-hospital mortality (12% vs 2%, p<0,001, Figure). During follow-up, 22 patients received ICD for primary and 4 for secondary prevention (two of the later had adequate ICD-therapy). In those discharged alive (n=1646), VF patients (n=91) had low mortality (1%) and combined endpoint rate (3%) that did not differ compared to NoVF patients (4% and 4% respectively).
Conclusion: In a large non-selected population of STEMI patients treated by primary PCI, VF during the first 48h of STEMI is associated with increased in-hospital mortality but does not influence the long-term prognosis for those discharged alive
- © 2011 by American Heart Association, Inc.