Clinical Electrophysiology -> SCA Risk Assessment: -> Clinical Risk Assessment Techniques D-PO03 - Poster Session III (ID 48) Poster

D-PO03-237 - Incidence And Prognosis Of In-hospital Ventricular Fibrillation Complicating Acute Myocardial Infarction: Temporal Trends Over A 20-year Period (ID 1171)

Abstract

Background: Sudden cardiac arrest remains a major complication despite improvements in acute myocardial infarction (AMI) management over the past two decades. Temporal trends and outcomes with respect to ventricular fibrillation (VF) during AMI have not been evaluated.
Objective: To assess trends in occurrence, influencing factors and one-year mortality of in-hospital VF in patients with AMI.
Methods: We analyzed data from five French nationwide prospective cohort studies, each conducted five years apart (overall 1995 to 2015), including totally 14,406 (66 ±14 years, 72% male, mean LVEF 52%) AMI patients (59% ST elevation MI/STEMI) admitted to cardiac intensive care units.
Results: Overall, 359 (2.5%) patients had VF during the AMI admission. Proportion of VF decreased from 3.9% in 1995 to 1.8% in 2015 (P<0.001). Factors significantly associated with lower VF incidence were year of MI occurrence (2015 vs 1995: OR 0.53, 95%CI 0.38-0.73), female gender (OR 0.72, 95%CI 0.55-0.94), history of hypertension (OR 0.78, 95%CI 0.62-0.98), hypercholesterolemia (OR 0.70, 95%CI 0.56-0.89), whereas STEMI (OR 2.22, 95%CI 1.70-2.90) was associated with higher risk. Overall one-year mortality was 12.0% (n=1,732) and decreased over the study period from 17.2% to 7.1% (P<0.001). Among those who had VF, one-year mortality decreased from 60.7% to 28.6% (P<0.001) and resulted from a decrease of both in-hospital mortality (45.2% to 22.9%, P<0.001) and later mortality (28.3% to 7.4%, P=0.001). Occurrence of VF (HR 5.48, 95%CI 4.61-6.51), age (HR 1.045, 95%CI 1.03-1.06), year of MI occurrence (2015 vs 1995) (HR 0.32, 95%CI 0.19-0.54), diabetes (HR 1.49, 95%CI 1.03-2.16) and anterior STEMI (HR 1.71, 95%CI 1.14-2.54) were all independently associated with one-year mortality. Adjusted HR for one-year mortality for patients who experienced VF (vs no VF) was 6.88 (95%CI 5.10-9.29) in 1995 and 7.07 (95%CI 4.47-11.19) in 2015.
Conclusion: Although occurrence of in-hospital VF, as well as absolute mortality related to VF in the setting of AMI has significantly decreased over the last 20 years, VF remains steadily associated with a relative 7-fold increased risk of one-year mortality, emphasizing the need for continued improvements in management strategies.
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