Prognosis of late versus early ventricular fibrillation in acute myocardial infarction (original) (raw)
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European Journal of Heart Failure, 2006
Aims: To characterize the relationship between known and newly diagnosed atrial fibrillation (AF) and the risk of death and major cardiovascular (CV) events in patients with acute myocardial infarction (MI) complicated by heart failure (HF) and/or left ventricular systolic dysfunction (LVSD). Methods: The VALIANT trial enrolled 14,703 individuals with acute MI complicated by HF and/or LVSD. AF was assessed at presentation and at randomization (median 4.9 days after symptom onset). Primary outcomes were risk of death and major CVevents 3 years following acute MI. Results: A total of 1812 with current AF (AF between presentation and randomization), 339 patients with prior AF (history of AF without current AF), and 12,509 without AF were enrolled. Patients with AF were older; had more prior HF, angina, and MI, and received beta-blockers and thrombolytics less often than those without AF. Three-year mortality estimates were 20% in those without AF, 37% with current AF, and 38% with prior AF. Compared with patients without AF, the multivariable adjusted HR of death was 1.25 (1.03 -1.52; p = 0.03) for prior AF and 1.32 (1.20 -1.45; p < 0.0001) for current AF. HR for major CV events was 1.15 (0.98 -1.35; p = 0.08) and 1.21 (1.12 -1.31; p < 0.0001). Conclusion: AF is associated with greater long-term mortality and adverse CV events with acute MI complicated by HF or LVSD.
Prognosis of early versus late ventricular fibrillation complicating acute myocardial infarction
International Journal of Cardiology, 1994
Earlier studies have suggested that patients exhibiting late ( > 24 h) ventricular fibrillation during acute myocardial infarction had a poorer outcome in comparison to myocardial infarction patients with early ( < 24 h) ventricular fibrillation. Between August 1981 and July 1983, 5839 consecutive patients with acute myocardial infarction were hospitalized in 13 out of 21 operating coronary care units in Israel. Demographic and medical data were collected from hospitalization charts and during I year of follow-up. Mortality assessment was done for 99% of hospital survivors up to mid-1988 (mean, 5.5 years). The incidence of ventricular fibrillation in the SPRINT Registry was 6% (37115839).
European Heart Journal, 2014
Limited data are available on long-term prognosis or causes-of-death analysis among survivors of acute myocardial infarction (MI) according to whether or not they developed ventricular fibrillation (VF) during the acute stage of MI. Methods and results Among 3670 MI patients hospitalized in France in 2005 and enrolled in this prospective follow-up cohort study, we assessed in-hospital mortality and 5-year cause of death among those who survived to hospital discharge, according to whether they developed VF (116 cases) or not, during the acute stage. 94.5% of patients had complete follow-up at 5 years. In-hospital mortality was significantly higher among VF patients (adjusted OR 7.38, 95% CI 4.27-12.75, P , 0.001). Among 3463 survivors at hospital discharge, 1024 died during a mean follow-up of 52 + 2 months. The overall survival rate at 5 years was 74.4% (95% CI 72.8-76.0). In Cox multivariate analysis, occurrence of VF during the acute phase of MI was not associated with an increased mortality at 5 years (HR 0.78, 95% CI 0.38-1.58, P ¼ 0.21). The distribution of causes of death at 5 years did not statistically differ according to the presence or absence of VF, especially for sudden cardiac death (13.1% in VF group vs.12.9% in non-VF group), despite a very low rate of implantation of cardioverter defibrillator in both groups (Overall rate 1.2%). Conclusion Patients developing VF in the setting of acute MI are at higher risk of in-hospital mortality. However, VF is not associated with a higher long-term all-cause or sudden cardiac death mortality.
Quantitative imaging in medicine and surgery, 2021
Background: The most common, potentially fatal complication following an acute myocardial infarction (AMI) is early ventricular fibrillation (EVF). According to the guidelines, the assessment of implanting an implantable cardioverter defibrillator (ICD) is sufficient 6 weeks after the event, in patients with reduced left ventricular ejection fraction (LVEF), regardless of VF. The present study aimed to evaluate the 6-week prognosis of patients surviving an EVF. We divided the patients in two group based on their general condition at the time they left the hospital. We investigated the clinical characteristics of patients discharged in good general health but still dying within 6 weeks. Methods: The present study comprised 12,270 patients with AMI following their primary revascularization in the first 12 h of symptom onset. Five hundred and forty-seven of them suffered EVF due to the AMI. Clinical and 6-week mortality data were examined. Results: Poor general condition correlates with multiple comorbidities, higher troponin levels, more severe complications after the event. Patients leaving in good condition thought to be low risk, from dying. But low LVEF, high blood sugar, high cardiac biomarker level, poor renal function elevates the risk of dying within 6 weeks. However, there is no difference in clinical characteristics between EVF− cases and EVF+ cases in good condition who dies within 6 weeks. Conclusions: According to our study we can select patients who are safe in the critical 6-week period and those who need closer follow-up despite leaving in good general condition.
Late clinical outcome in patients with early ventricular fibrillation after myocardial infarction
Journal of the American College of Cardiology, 1988
Son Lx<,?", Cuwrni" ""cl "onco,,wr. Canodll Whether ventricutnr Bbrittrltio" murriag within 48 h snrr fibrillation (8 VLMI l4%, rer~+ct,ve,y). Sbnitar mortality rate myocnrdi~l infarction is associated with Qsr(iculnr results were found when oolv wlmsrv ("at awciated wilh clinical fealurer and poor prognwis, erp-xialty i patients with anterior mywardial infarction, is SfiU debated. There. fore, clinical variables and iwhospitat and I yew mortality rates were annlymd in 2,089 Qatiek,t5. sgul LB to 95 years Onema 2 SD 44 f 12,. admitted to the bm9,tat with e;,w myoaxdkd infarction between ,979 and mid 1%?4. Or,c hundred iortyseven patients (7%) had at least ooe epM~ of ventricular fibrillation occurring within 48 h of bmQHnl admission. Ofthese, 2.55% died dvrtngthoir tnttiel hwpttat. ization compared with 13% of pad&s without arty ven. trieular tibrillntioa (p < 0.00,). In ,506 ofpatimts 4th early ventricular fibrillation, the tmmedtste cause of death war left ventricular failure or cardiogenic shwk.
Journal of the American College of Cardiology, 1990
and programmed electrical stimulation (8-14). However. the role of the clinical history and 12 lead ECG in determining prognosis is not we!! established. Therefore, the present Dutch multicenter study was initiated in 1984. Its aims were !) to assess PrOgnOSiS in patients with symptomatic ventricular tachycardia or ventr!cu!ar fibrillation late after infarction, and 2) to identify those baseline characteristics that independently determine prognosis; both evaluations were limited to ~jtiti~m receiving standard antiarrhythmic treatment. The study was designed as a prospective nonrandomized follow-up investigation. Organization. The study was carried out under the auspices of the Interuniversity Cardiology Institute of The Netherlands. Thirteen cardiology departments participated (see Appendix). The first patient was enrolled on April I, 1984 and the last on April I, 1987. Central registry and processing of the data were done at the Department of Clinical and Experimental cardiology of the Academic Medical Center in Amsterdam. A steering committee was responsible for the scientific conduct of the study. Patient selection. Patients with documented sustained ventricular tachycardia or fibrillation occurring ~48 h after the onset of myocardial infarction were eligible for the study, provided that at least one of the following symptoms occurred during the arrhythmia: palpitation, chest pain, dyspnea, dizziness, syncope or cardiac arrest. The diagnosis of (previous) myocardia! infarction was based on the presence of at least two of the following criteria: I) pathologic Q waves on the ECG meeting Minnesota Code Manual criteria (13; 2) elevation of cardiac serum enzymes; and 1) abnormal wall motion as documented by echocardiography, scintigraphy or angiography. Patients were not registered if the attending cardiologist attributed the ventricular tachyarrhythmia to pump failure, ischemia or imbalance of serum electrolytes. In addition, participating cardiologists did not register patients if the arrhythmia was considered to be caused by proarrhythmic effects of an antiarrhythmic drug. Proarrhythmic effects of drugs were considered in cases in which ventricdar fibrillation or a ventricular tachycardia with a rate >250 beatslmin occurred within 30 days after the prescription of 'kre drug (16). The records of a!! patients were retrospectively reviewed by the study coordinator (A. R. W.); patients whose entry criteria had been unequivd from the registry. Patients were initially treated with an antiarrhythmic drug; if this failed, a second drug was prescribed; and if that failed, a third drug was given. The first two drugs were preferably class 1 antiarrhythmic drugs (17). such as procainamide, quinidine, disopyramide, flecainide and Propafenone.
Atrial fibrillation, ischaemic heart disease, and the risk of death in patients with heart failure
European Heart Journal, 2006
Aims Atrial fibrillation (AF) is a risk factor for death in patients with a myocardial infarction, but highly variable results are reported in patients with heart failure. We studied the prognostic impact of AF in heart failure patients with and without ischaemic heart disease. Methods and results During a period of 2 years, 3587 patients admitted to hospital because of heart failure were included in this study. All patients were examined by echocardiography and the presence of AF was recorded. Follow-up was available for 8 years. Twenty four percent of those discharged alive from hospital had AF. After 4 and 8 years of follow-up, mortality was higher in patients with AF than in patients without, 56 vs. 52% and 77 vs. 73%, respectively. Cox multivariable regression analysis showed a small but significant importance of AF for long-term mortality [hazard ratio (HR) 1.12, 95% confidence limits (CI), 1.02-1.23, P ¼ 0.018]. There was a significant interaction between the importance of AF and the presence of ischaemic heart disease (P ¼ 0.034). In patients with AF at the time of discharge and ischaemic heart disease, HR was 1.25 (95% CI: 1.09-1.42) and P , 0.001; in patients with AF at discharge and without ischaemic heart disease, HR was 1.01 (95% CI: 0.88-1.16) and P ¼ 0.88. Conclusion AF is associated with increased risk of death only in patients with ischaemic heart disease. This finding may explain the variable results of studies of the prognosis associated with AF in heart failure.