title: Prehospital cardiac arrest: a marker for higher mortality in patients with acute myocardial infarction and moderately reduced left ventricular function: results from the MITRA plus registry.
abstract: BACKGROUND
  According to the current guidelines for acute myocardial infarction, ventricular fibrillation during the acute phase of myocardial infarction is no indication for specific treatment like ICD implantation. Primary objective of our study was to evaluate the prognostic significance of cardiac arrest within the acute phase of myocardial infarction in patients with moderately reduced left ventricular function.
  
  
  RESULTS
  From 1994 until 2004, we included 7111 patients with acute STEMI and an LVEF >30% from the MITRA plus registry who were discharged alive from hospital and had a complete follow up. We compared long term prognosis on total mortality in patients with and without prehospital cardiac arrest. 286 out of 7111 patients (4%) with moderately reduced LVEF >30% after STEMI had prehospital cardiac arrest and were discharged alive from hospital. In these patients, total mortality during a mean follow up of 13 months was 13.6% compared to 8.7% in patients without cardiac arrest, although patients with cardiac arrest were younger and had less risk factors. Higher mortality after cardiac arrest was independent from gender, risk factors and medical treatment. Only in patients with preserved LVEF >55% after STEMI, mortality was equal in patients with and without cardiac arrest.
  
  
  CONCLUSIONS
  Prehospital cardiac arrest in the acute phase of STEMI is an independent risk indicator for higher mortality in patients with moderately reduced left ventricular function (LVEF 30-55%). To evaluate the prognostic impact of the implantation of an ICD in these patients, further investigation is needed.
authors.affiliation: Herzzentrum Ludwigshafen, Bremserstrasse 79, 67063 Ludwigshafen, Germany. maggie-ma@t-online.de
authors.forename: Margit
authors.initials: M
authors.lastname: Strauss
authors.forename: Anselm Kai
authors.initials: AK
authors.lastname: Gitt
authors.forename: Torsten
authors.initials: T
authors.lastname: Becker
authors.forename: Thomas
authors.initials: T
authors.lastname: Kleemann
authors.forename: Rudolf
authors.initials: R
authors.lastname: Schiele
authors.forename: Harald
authors.initials: H
authors.lastname: Darius
authors.forename: Claus
authors.initials: C
authors.lastname: Jünger
authors.forename: Jochen
authors.initials: J
authors.lastname: Senges
authors.forename: Karlheinz
authors.initials: K
authors.lastname: Seidl
mesh_terms: D000368:Aged; D015897:Comorbidity; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D005260:Female; D005858:Germany / Q000453:epidemiology; D006323:Heart Arrest / Q000401:mortality*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality*; D011379:Prognosis; D012042:Registries / Q000706:statistics & numerical data*; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D016019:Survival Analysis; D015996:Survival Rate; D018487:Ventricular Dysfunction, Left / Q000401:mortality*