Abstract 249: Primary Ventricular Fibrillation in ST-Elevation Myocardial Infarction Remains the Major Early Complication
Some data from in-hospital cohorts show that Primary Ventricular Fibrillation (pVF) is declining in patients with ST-Elevation Myocardial Infarction (STEMI). Our objective is to assess the current incidence, associated factors and early mortality of pVF in a pre-hospital cohort of STEMI patients.
Methods Prospective cohort of unselected STEMI patients cared for by pre-hospital emergency teams in Andalusia. We analyzed the documented pVF episodes either as initial rhythm or as a complication before in-hospital admission. Univariate and multivariate analysis.
Results Of 5529 patients included, 412(7.45%) had at least one pVF episode. All patients were treated, 383(92.9%) were admitted and 288(69.9%) were discharged alive. Univariate analysis: pVF patients are: younger (56.7vs64.1,p<0.0001), male (8.2% vs 5.%,p=0.001), no diabetes (4.8% vs 8.5%,p< 0.0001), no hypertension (6.2% vs 8.9%, p<0.0001), no dyslipidemia (5.7% vs 8.5%,p<0.0001), no prior myocardial infarction (5.6% vs 7.7%,p=0.04), shorter interval from onset-symptoms to call-EMS (63.6 vs 169.8,p<0.0001, median in minutes, p<0.0001), larger infarctions (≥5 leads, 7.9% vs 6.3%,p=0.03), hypotension (95.4 vs 125 mmHG,p<0.0001), higher early mortality: on scene (36,3% vs 7%,p<0.0001) and in-hospital(13.5% vs 6.6%,p<0.0001). 1-month and 1-year mortality were not associated to pVF. pVF patients received more rescue PCI (12.6% vs 7.2%,p<0.0001) but no other reperfusion treatments.
Multivariate analysis: pVF was associated to younger patients (OR:0.978;CI 0969-0.987,p<0.0001), neither diabetes (OR:1.063;CI 1.150-2.234,p=0.005) nor dyslipidemia (OR:1.429;CI:1.091-1.872,p=0.01), hypotension (OR:0.986;CI 0983-0.989,p<0.0001), shorter interval symptoms (OR:0.998;CI:0997-0.999,p<0.0001) and early mortality (OR:2.390;CI 1.673-3.415,p<0.0001). They receive more rescue-PCI (OR:1.938;CI 1.362-2.759,p<0.0001).
Conclusions. The incidence of pVF in STEMI remains high when testing a pre-hospital cohort. It's an early complication, in younger patients without traditional risk factors, with hypotension during the episode and with high early mortality. Nevertheless, after discharge, the prognosis is as good as in no pVF patients.
- Ventricular fibrillation
- Myocardial infarction, STEMI
- Sudden cardiac death
- Healthcare delivery systems
- © 2011 by American Heart Association, Inc.