Incidence and prognosis of early primary ventricular fibrillation in acute myocardial infarction--results of the Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto Miocardico (GISSI-2) database.
Primary ventricular fibrillation (VF) complicating acute myocardial infarction (MI) predicts short-term mortality. The broad category of patients with primary VF might include subgroups with different outcomes. It is still not certain whether early-onset (< or =4 hours) primary VF is a risk predictor, and information on correlates of these early fibrillations is scarce. This study sought to prospectively analyze the incidence and prognosis of early, as opposed to late (time window >4 to 48 hours) primary VF and retrospectively identify predisposing factors for early-onset primary VF. We analyzed the incidence and recurrence rate of early and late primary VF in 9,720 patients with a first acute MI, treated with thrombolytics, enrolled in the Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto Miocardico (GISSI)-2 trial. The independent prognostic significance of early and late primary VF was assessed by logistic regression analysis. The incidence rates of early and late primary VF were 3.1% and 0.6%, respectively; recurrence rates were 11% and 15%, respectively. The 2 variables most closely related to early primary VF were hypokalemia and systolic blood pressure < 120 mm Hg on admission. Patients with early primary VF had a more complicated in-hospital course than matched controls. Both early (odds ratio [OR] 2.47, 95% confidence interval [CI] 1.48 to 4.13) and late primary VF (OR 3.97, 95% CI 1.51 to 10.48) were independent predictors of in-hospital mortality. Postdischarge to 6-month death rates were similar for both primary VF subgroups and controls. Primary VF, irrespective of its timing, was an independent predictor of in-hospital mortality. Postdischarge to 6-month prognosis was unaffected by the occurrence of either early or late primary VF.
Associazione Nazionale Medici Cardiologi Ospedalieri, Florence, Italy.
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Volpi
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Cavalli
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Santoro
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Negri
D000889:Anti-Arrhythmia Agents / Q000008:administration & dosage / Q000627:therapeutic use; D000925:Anticoagulants / Q000008:administration & dosage / Q000627:therapeutic use; D001241:Aspirin / Q000008:administration & dosage / Q000627:therapeutic use; D001262:Atenolol / Q000008:administration & dosage / Q000627:therapeutic use; D004333:Drug Administration Routes; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006493:Heparin / Q000008:administration & dosage / Q000627:therapeutic use; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D008012:Lidocaine / Q000008:administration & dosage / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications* / Q000188:drug therapy; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use; D011379:Prognosis; D012008:Recurrence; D012042:Registries; D012189:Retrospective Studies; D015996:Survival Rate; D014693:Ventricular Fibrillation / Q000188:drug therapy / Q000453:epidemiology* / Q000209:etiology
D000889:Anti-Arrhythmia Agents; D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors; D001262:Atenolol; D006493:Heparin; D008012:Lidocaine; D001241:Aspirin