title: Prognosis after cardiac arrest due to ventricular tachycardia or ventricular fibrillation associated with acute myocardial infarction (the MILIS Study). Multicenter Investigation of the Limitation of Infarct Size.
abstract: Previous studies have reached conflicting conclusions about whether cardiac arrest due to ventricular tachycardia (VT) or ventricular fibrillation (VF) in acute myocardial infarction (AMI) is of long-term prognostic significance. The mortality rate in 849 patients with confirmed AMI was analyzed. The mortality rate during the initial hospitalization was higher for patients in whom VT/VF occurred (27% vs 7%, p less than 0.001). The in-hospital mortality rate for patients with primary VT/VF, that is, VT/VF occurring in the absence of hypotension or heart failure, was similar to that of patients who did not have VT/VF (8% vs 7%, difference not significant), whereas the rate for patients with secondary VT/VF was significantly greater than that for patients with no VT/VF (51% vs 7%, p less than 0.001). The timing of occurrence of VT/VF also influenced mortality: Patients in whom VT/VF occurred more than 72 hours after admission had a higher in-hospital mortality rate than did patients in whom it occurred within 72 hours (57% vs 20%, p less than 0.05). All cases of primary VT/VF occurred within the first 72 hours of admission. The long-term mortality rate for hospital survivors was not significantly different for patients who had had VT/VF during acute infarction compared with those who had not (19% vs 21%) (mean follow-up 32 months). Thus, cardiac arrest due to ventricular tachyarrhythmia was associated with a higher in-hospital mortality rate but was not a prognostic factor among hospital survivors. Patients resuscitated from primary VT/VF, which characteristically occurs early after AMI, do not have an adverse prognosis.
authors: Harvard Medical School, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts 02115.
authors: G H
authors: GH
authors: Tofler
authors: P H
authors: PH
authors: Stone
authors: J E
authors: JE
authors: Muller
authors: J D
authors: JD
authors: Rutherford
authors: S N
authors: SN
authors: Willich
authors: N F
authors: NF
authors: Gustafson
authors: W K
authors: WK
authors: Poole
authors: B E
authors: BE
authors: Sobel
authors: J T
authors: JT
authors: Willerson
authors: T
authors: T
authors: Robertson
mesh_terms: D000368:Aged; D005260:Female; D006323:Heart Arrest / Q000209:etiology* / Q000401:mortality; D006334:Heart Function Tests; D006352:Heart Ventricles; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications* / Q000401:mortality; D011336:Probability; D011379:Prognosis; D013610:Tachycardia / Q000150:complications* / Q000401:mortality; D013997:Time Factors; D014693:Ventricular Fibrillation / Q000150:complications* / Q000401:mortality