Impact of the angiographic burden on the incidence of out-of-hospital ventricular fibrillation in patients with acute myocardial infarction.

Abstract

Ventricular fibrillation (VF) is a catastrophic complication of spontaneous (type 1) acute myocardial infarction (AMI). This study sought to clarify the angiographic coronary characteristics related to out-of-hospital VF in AMI patients. We retrospectively reviewed 464 consecutive cases of suspicious AMI, including type 1 AMI, with or without out-of-hospital VF. In addition to patient demographics, proximal left coronary artery (LCA) disease, multivessel disease (MVD), and chronic total occlusion (CTO) were assessed via coronary angiography and compared between patients with and without out-of-hospital VF. Coronary angiography was evaluated for 74 patients with out-of-hospital VF and for 237 without. Male sex (93.2 vs. 83.1%; P = 0.036), Killip class ≥ 2 (89.2 vs. 16.5%; P < 0.001), and ST elevation myocardial infarction (83.8 vs. 66.7%; P = 0.003) were more frequent in the out-of-hospital VF group. The culprit lesions located in the proximal left coronary artery (62.2 vs. 29.5%; P < 0.001), MVD (75.7 vs. 41.8%, P < 0.001), and CTO (43.2 vs. 10.5%, P < 0.001) were more frequently observed in patients with out-of-hospital VF. Multivariate logistic regression analysis identified the culprit lesion located in the proximal LCA [odds ratio (OR) 2.86; 95% confidence interval (CI) 1.34-6.08], the presence of CTO (OR 8.52; 95% CI 3.35-21.65), and MVD (OR 3.69; 95% CI 1.57-8.65) as predictors of out-of-hospital VF. For type 1 AMI patients, advanced disease burden including the culprit lesion located in the proximal LCA and coexistence of CTO or MVD might be associated with out-of-hospital VF.