title: Incidence and risk factors of ventricular fibrillation before primary angioplasty in patients with first ST-elevation myocardial infarction: a nationwide study in Denmark.
abstract: BACKGROUND
  We aimed to investigate the incidence and risk factors for ventricular fibrillation (VF) before primary percutaneous coronary intervention (PPCI) among patients with ST-segment elevation myocardial infarction (STEMI) in a prospective nationwide setting.
  
  
  RESULTS
  In this case-control study, patients presenting within the first 12 hours of first STEMI who survived to undergo angiography and subsequent PPCI were enrolled. Over 2 years, 219 cases presenting with VF before PPCI and 441 controls without preceding VF were enrolled. Of the 219 case patients, 182 (83%) had STEMI with out-of-hospital cardiac arrest due to VF, and 37 (17%) had cardiac arrest upon arrival to the emergency room. Medical history was collected by standardized interviews and by linkage to national electronic health records. The incidence of VF before PPCI among STEMI patients was 11.6%. Multivariable logistic regression analysis identified novel associations between atrial fibrillation and alcohol consumption with VF. Patients with a history of atrial fibrillation had a 2.80-fold odds of experiencing VF before PPCI (95% CI 1.10 to 7.30). Compared with nondrinkers, patients who consumed 1 to 7 units, 8 to 14 units, or >15 units of alcohol per week had an odds ratio (OR) of 1.30 (95% CI, 0.80 to 2.20), 2.30 (95% CI, 1.20 to 4.20), or 3.30 (95% CI, 1.80 to 5.90), respectively, for VF. Previously reported associations for preinfarction angina (OR 0.46; 95% CI 0.32 to 0.67), age of <60 years (OR 1.75; 95% CI 1.20 to 2.60), anterior infarction (OR 2.10; 95% CI 1.40 to 3.00), preprocedural thrombolysis in myocardial infarction flow grade 0 (OR 1.65; 95% CI 1.14 to 2.40), and family history of sudden death (OR 1.60; 95% CI 1.10 to 2.40) were all associated with VF.
  
  
  CONCLUSIONS
  Several easily assessed risk factors were associated with VF occurring out-of-hospital or on arrival at the emergency room before PPCI in STEMI patients, thus providing potential avenues for investigation regarding improved identification and prevention of life-threatening ventricular arrhythmias.
authors.affiliation: Danish National Research Foundation Centre for Cardiac Arrhythmia (DARC), University of Copenhagen, Denmark (R.J., C.G., B.R., J.J., B.G.W., J.H.S., S.H., J.T.H.) Laboratory of Molecular Cardiology, Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark (R.J., T.E., C.G., B.R., J.J., B.G.W., F.P., J.H.S., S.H., J.T.H.).
authors.forename: Reza
authors.initials: R
authors.lastname: Jabbari
authors.affiliation: Laboratory of Molecular Cardiology, Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark (R.J., T.E., C.G., B.R., J.J., B.G.W., F.P., J.H.S., S.H., J.T.H.) Department of Clinical Medicine, University of Copenhagen, Denmark (T.E., J.H.S., S.H., J.T.H.).
authors.forename: Thomas
authors.initials: T
authors.lastname: Engstrøm
authors.affiliation: Danish National Research Foundation Centre for Cardiac Arrhythmia (DARC), University of Copenhagen, Denmark (R.J., C.G., B.R., J.J., B.G.W., J.H.S., S.H., J.T.H.) Laboratory of Molecular Cardiology, Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark (R.J., T.E., C.G., B.R., J.J., B.G.W., F.P., J.H.S., S.H., J.T.H.).
authors.forename: Charlotte
authors.initials: C
authors.lastname: Glinge
authors.affiliation: Danish National Research Foundation Centre for Cardiac Arrhythmia (DARC), University of Copenhagen, Denmark (R.J., C.G., B.R., J.J., B.G.W., J.H.S., S.H., J.T.H.) Laboratory of Molecular Cardiology, Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark (R.J., T.E., C.G., B.R., J.J., B.G.W., F.P., J.H.S., S.H., J.T.H.).
authors.forename: Bjarke
authors.initials: B
authors.lastname: Risgaard
authors.affiliation: Danish National Research Foundation Centre for Cardiac Arrhythmia (DARC), University of Copenhagen, Denmark (R.J., C.G., B.R., J.J., B.G.W., J.H.S., S.H., J.T.H.) Laboratory of Molecular Cardiology, Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark (R.J., T.E., C.G., B.R., J.J., B.G.W., F.P., J.H.S., S.H., J.T.H.).
authors.forename: Javad
authors.initials: J
authors.lastname: Jabbari
authors.affiliation: Danish National Research Foundation Centre for Cardiac Arrhythmia (DARC), University of Copenhagen, Denmark (R.J., C.G., B.R., J.J., B.G.W., J.H.S., S.H., J.T.H.) Laboratory of Molecular Cardiology, Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark (R.J., T.E., C.G., B.R., J.J., B.G.W., F.P., J.H.S., S.H., J.T.H.).
authors.forename: Bo Gregers
authors.initials: BG
authors.lastname: Winkel
authors.affiliation: Department of Cardiology, Aarhus University Hospital in Skejby, Aarhus, Denmark (C.J.T.).
authors.forename: Christian Juhl
authors.initials: CJ
authors.lastname: Terkelsen
authors.affiliation: Department of Cardiology, Aalborg University Hospital, Copenhagen, Denmark (H.H.T.).
authors.forename: Hans-Henrik
authors.initials: HH
authors.lastname: Tilsted
authors.affiliation: Department of Cardiology, Odense University Hospital, Denmark (L.O.J., M.H.).
authors.forename: Lisette Okkels
authors.initials: LO
authors.lastname: Jensen
authors.affiliation: Department of Cardiology, Odense University Hospital, Denmark (L.O.J., M.H.).
authors.forename: Mikkel
authors.initials: M
authors.lastname: Hougaard
authors.affiliation: Center for Arrhythmia Prevention, Division of Preventive Medicine, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (S.E.C., C.M.A.).
authors.forename: Stephanie E
authors.initials: SE
authors.lastname: Chiuve
authors.affiliation: Laboratory of Molecular Cardiology, Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark (R.J., T.E., C.G., B.R., J.J., B.G.W., F.P., J.H.S., S.H., J.T.H.).
authors.forename: Frants
authors.initials: F
authors.lastname: Pedersen
authors.affiliation: Danish National Research Foundation Centre for Cardiac Arrhythmia (DARC), University of Copenhagen, Denmark (R.J., C.G., B.R., J.J., B.G.W., J.H.S., S.H., J.T.H.) Laboratory of Molecular Cardiology, Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark (R.J., T.E., C.G., B.R., J.J., B.G.W., F.P., J.H.S., S.H., J.T.H.) Department of Clinical Medicine, University of Copenhagen, Denmark (T.E., J.H.S., S.H., J.T.H.).
authors.forename: Jesper Hastrup
authors.initials: JH
authors.lastname: Svendsen
authors.affiliation: Danish National Research Foundation Centre for Cardiac Arrhythmia (DARC), University of Copenhagen, Denmark (R.J., C.G., B.R., J.J., B.G.W., J.H.S., S.H., J.T.H.) Laboratory of Molecular Cardiology, Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark (R.J., T.E., C.G., B.R., J.J., B.G.W., F.P., J.H.S., S.H., J.T.H.) Department of Clinical Medicine, University of Copenhagen, Denmark (T.E., J.H.S., S.H., J.T.H.).
authors.forename: Stig
authors.initials: S
authors.lastname: Haunsø
authors.affiliation: Center for Arrhythmia Prevention, Division of Preventive Medicine, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (S.E.C., C.M.A.).
authors.forename: Christine M
authors.initials: CM
authors.lastname: Albert
authors.affiliation: Danish National Research Foundation Centre for Cardiac Arrhythmia (DARC), University of Copenhagen, Denmark (R.J., C.G., B.R., J.J., B.G.W., J.H.S., S.H., J.T.H.) Laboratory of Molecular Cardiology, Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark (R.J., T.E., C.G., B.R., J.J., B.G.W., F.P., J.H.S., S.H., J.T.H.) Department of Clinical Medicine, University of Copenhagen, Denmark (T.E., J.H.S., S.H., J.T.H.).
authors.forename: Jacob
authors.initials: J
authors.lastname: Tfelt-Hansen
mesh_terms: D017677:Age Distribution; D000368:Aged; D000428:Alcohol Drinking / Q000453:epidemiology; D015906:Angioplasty, Balloon, Coronary / Q000379:methods* / Q000401:mortality; D016022:Case-Control Studies; D016757:Death, Sudden, Cardiac / Q000453:epidemiology*; D003718:Denmark; D004562:Electrocardiography / Q000379:methods; D005260:Female; D006801:Humans; D015994:Incidence; D008019:Life Style; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D017678:Sex Distribution; D012907:Smoking / Q000453:epidemiology; D018709:Statistics, Nonparametric; D016896:Treatment Outcome; D014693:Ventricular Fibrillation / Q000175:diagnosis / Q000453:epidemiology*
keywords: myocardial infarction; sudden death; ventricular fibrillation