Unselected ST-elevation Myocardial Infarction Patients Research Articles

Predictors of sudden cardiac death in long-term follow-up in patients with ST-elevation myocardial infarction treated with primary percutaneous coronary intervention

Abstract Funding Acknowledgements Type of funding sources: None. Background Despite timely and successful reperfusion tretment with primary percutaneous coronary intervention (pPCI), some patients have a high risk of mortality and SCD. Aim The aim of our study was to analyze the incidence of SCD and determine the predictors of SCD occurrence during 6-year follow-up of patients with ST-elevation myocardial infarction (STEMI), treated with primary PCI. Method we analysed 3114 consecutive STEMI patients. Patients presenting with cardiogenic schock were excluded. Echocardiographic examination was performed before hospital discharge and left ventricular ejection fraction (EF) was calculated using bi-plane method. The follow-up period was 6 years. Results During 6-year follow-up, lethal outcome was registered in a total of 297 (9.5%) patients, of whom 95 (31.9%) had SCD. The highest incidence of SCD was recorded in the first year of follow-up, when SCD was registered in 25 patients, which is 26.3% of the total number of patients who had had SCD, i.e., 0.8% of the patients analyzed (Figure 1). The independent predictors for the occurrence of SCD during 6-year follow-up were EF<45% (HR 3.07, 95% 1.87-5.02), post-procedural TIMI flow <3 (HR 2.59, 95%CI 1.37-5.14), reduced baseline kidney function (HR 1.87, 95%CI 1.12-2.93) and Killip class >1 at admission (HR 1.69, 95%CI 1.23-2.97). Conclusion There is a low incidence of SCD in unselected STEMI patients treated with primary PCI. The independent predictors of SCD during long-term follow-up, in the patients analyzed, are: EF ≤ 45%, post-procedural flow TIMI < 3, Killip class > 1, and reduced baseline kidney function.

Sudden cardiac death in long-term follow-up in patients treated with primary percutaneous coronary intervention

Objective. Most studies analyzing predictors of sudden cardiac death (SCD) after acute myocardial infarction included only high-risk patients or index reperfusion had not been performed in all patients. The aim of our study was to analyze the incidence of SCD and determine the predictors of SCD occurrence during 6-year follow-up of unselected patients with ST-elevation myocardial infarction (STEMI), treated with primary percutaneous coronary intervention (pPCI). Method. we analysed 3114 STEMI patients included included in the University Clinical Center of Serbia STEMI Register. Patients presenting with cardiogenic schock were excluded. Echocardiographic examination was performed before hospital discharge. Results. During 6-year follow-up, lethal outcome was registered in 297 (9.5%) patients, of whom 95 (31.9%) had SCD. The highest incidence of SCD was recorded in the first year of follow-up, when SCD was registered in 25 patients, which is 26.3% of the total number of patients who had had SCD, i.e. 0.8% of the patients analyzed. The independent predictors for the occurrence of SCD during 6-year follow-up were EF < 45% (HR 3.07, 95% 1.87–5.02), post-procedural TIMI flow <3 (HR 2.59, 95%CI 1.37–5.14), reduced baseline kidney function (HR 1.87, 95%CI 1.12–2.93) and Killip class >1 at admission (HR 1.69, 95%CI 1.23–2.97). Conclusion. There is a low incidence of SCD in unselected STEMI patients treated with primary PCI. Predictors of SCD occurence during long-term follow-up in analyzed patients are clinical variables that are easily recorded during index hospitalization and include: EF ≤45%, post-procedural flow TIMI < 3, Killip class >1, and reduced baseline kidney function.

P5517Impact of admission during ON vs OFF hours on mortality in unselected ST-elevation myocardial infarction patients referred in percutaneous coronary intervention centers:insights from the ORBI registry

Abstract Background The effect of admission during OFF-hours on patient's outcome in ST Segment Elevation Myocardial Infarction remains controversial when a strategy for reperfusion between primary Percutaneous Coronary Intervention (pPCI) and fibrinolysis is chosen. We aimed to evaluate the impact of time of admission on all cause mortality in unselected STEMI patients referred to pPCI centers. Methods Data from 10850 consecutive patients admitted in the nine interventional cardiology centers in Britany for STEMI in the 24 first hours following the beginning of symptoms were collected in a network registry. Characteristics and clinical outcome of patients admitted during ON-hours (Monday through Friday 8h am-6h30 pm) were compared to OFF-hours patients (night shifts, weekends and non-working Holydays). Clinical outcome was all-cause in hospital mortality, major bleeding, and mechanical complications in STEMI. Results A total of 4644 confirmed STEMI patients (57.2%) were admitted during OFF-hours and 6206 (42.8%) patients during ON-hours. Baseline characteristics were well balanced between the two groups including features of high risk STEMI such as ventricular fibrillation (3.7% vs 3.6% p=0, 8), cardiogenic shock (6.9% vs 7.6%, p=0.1), mechanical complications (3,2% vs 2,7%, p=0,2). The population was older in the ON group (63.7 vs 62.2, p&lt;0.0001). Time from symptom onset to First Medical Contact (FMC) were slightly longer for patients presenting during on-hours (97 min vs. 95 min, p&lt;0,03). Time from FMC to angiography was longer during OFF-hours compared to ON-hours (100 min vs. 92 min p&lt;0,0001). Time from arrival in the PCI center to angioplasty was higher in the OFF period (40 mn vs 38 mn, p&lt;0.0001). The reperfusion treatment was different between the two periods, with more fibrinolysis and less PCI in OFF group (PCI: 76.7% vs 79.6%, p&lt;0,0001; Fibrinolysis: 11.4% vs 8.9%, p&lt;0,0001). The use of radial access (RA) was uniform in both group (66,8% and 66.6%; p=0,9) and not different whatever the admission time. The use of radial access increased meaningfully from 2008 for the two periods (RA OFF group: 84.4% vs 38,6%, RA ON group: 88.6% vs 38.7%) There was no impact of admission time on in-hospital all cause mortality in the entire population (5,3% vs 5,4% p=0,7), and on the Timi 3 flow for the patients treated with primary angioplasty (On group: 94% vs 94,3%, p=0.5). The bleeding complications were similar in both groups (2,5% vs 2,6%, p=0,8). Conclusions Even though the time of reperfusion is slightly longer in patients admitted for STEMI during off-hours, no difference was observed in the PTCA technique and success rates as well as in the in-hospital mortality and bleeding rates. A long term patient follow-up would be necessary before definite conclusions.

Impact of socioeconomic status on survival following ST-elevation myocardial infarction in a universal healthcare system

BackgroundLower socioeconomic status (SES) has been associated with worse outcomes after acute myocardial infarction. Data for survival after ST-elevation myocardial infarction (STEMI) by SES in the current era of primary percutaneous coronary intervention (PCI) is more limited. MethodsData was collected for all patients with acute STEMI undergoing primary PCI at The South Yorkshire Cardiothoracic Centre, UK between 2009 and 2014. A Cox regression analysis was used to assess differences in survival by SES quartile (using an area-level measure). ResultsOf the 3126 STEMI patients, 2655 (84.9%) were first presentations of STEMI. Lower SES groups generally had a less favourable baseline cardiovascular risk factor profile, with higher rates of smoking (p = 0.001), diabetes (p = 0.007) and previous coronary heart disease (p = 0.025). With the exception of beta-blockers, the use of secondary preventative medications was similar between SES quartiles. Adjusting for age and gender, the most disadvantaged SES quartile trended to a non-significant increased mortality at 30 days (hazard ratio 1.35 (0.79–2.33)), 1 year (1.12 (0.76–1.65)), or 3 years (1.22 (0.88–1.70)) compared to the least disadvantaged SES quartile, but this was attenuated by adjusting for additional cardiovascular risk factors and medication use on discharge. ConclusionsIn this large study of unselected STEMI patients managed by primary PCI, we did not find any significant differences in survival by SES at 30 days, 1 year, or 3 years.

P6441Impact of admission during ON vs OFF hours on mortality in unselected ST-elevation myocardial infarction patients referred in percutaneous coronary intervention centers:Insights from the ORBI registry

P6441Impact of admission during ON vs OFF hours on mortality in unselected ST-elevation myocardial infarction patients referred in percutaneous coronary intervention centers:Insights from the ORBI registry

TCT-160 Impact of admission during ON vs. OFF hours in unselected ST-Elevation Myocardial Infarction Patients treated with Primary Percutaneous Coronary Intervention.

TCT-160 Impact of admission during ON vs. OFF hours in unselected ST-Elevation Myocardial Infarction Patients treated with Primary Percutaneous Coronary Intervention.

Serious infections among unselected patients with ST-elevation myocardial infarction treated with contemporary primary percutaneous coronary intervention

Contemporary studies assessing the frequency, characteristics, and outcomes of serious infections (SIs) in patients presenting a ST-elevation myocardial infarction are scarce. Prospective cohort of consecutive patients undergoing primary percutaneous coronary intervention (pPCI). Serious infection was defined as the presence of infection that prolonged hospitalization. Community-acquired infection (CAI) was defined by SI diagnosed in the first 72 hours of hospitalization, whereas hospital-acquired infections (HAI) were those diagnosed after 72 hours of hospital admission. From December 2009 to November 2012, 1,486 patients were included in the analysis. Serious infection was present in 58 (3.9%) individuals; 30 (2%) patients had CAI and 28 (1.9%) patients had HAI. Respiratory tract infection was responsible for 82% of the SI. Patients with SI were older, had more comorbidities, and had worse angiographic results of the pPCI procedure when compared with those without SIs. After multivariable adjustment, SI was associated with an approximately 10-fold risk of 30-day death. Patients with CAI had more often a history of smoking, Killip III/IV on hospital admission, worse pPCI, and angiographic results than did patients with HAI. However, no differences were seen in 30-day major cardiovascular outcomes between patients with CAI and HAI. In a contemporary cohort of unselected ST-elevation myocardial infarction patients representative of the daily practice, SI was uncommon but associated with worse pPCI results and high risk of mortality. The occurrences of CAI or HAI were similar, but CAI patients presented distinctly worse angiographic outcomes than did patients with HAI.

Influence of manual thrombus aspiration on left ventricular diastolic function in patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention.

Data on effects of thrombus aspiration on left ventricular diastolic function in ST-elevation myocardial infarction (STEMI) population are scarce. We sought to compare echocardiographic indices of the diastolic function and outcomes in STEMI patients treated with and without manual thrombus aspiration, in an academic, high-volume percutaneous coronary intervention (PCI) center. A total of 433 consecutive patients who underwent primary PCI in 2011-2012 were enrolled in the study. Patients were not eligible for the study if they already suffered a myocardial infarction, had been previously revascularized, received thrombolytics, presented with cardiogenic shock, had significant valvular disease, atrial fibrillation or had previously implanted pacemaker. Comprehensive echocardiogram was performed within 48 hours. During follow-up patients'status was assessed by an office visit or telephone interview. Patients treated with thrombus aspiration (TA+, n=216) had similar baseline characteristics as those without thrombus aspiration (TA-, n = 217). Groups had similar total ischemic time (319 ± 276 vs. 333 ± 372 min; p = 0.665), but TA+ group had higher maximum values of troponin I (39.5 ± 30.5 vs. 27.6 ± 26.9 ng/ml; p < 0.001). The echocardiography revealed similar left ventricular volumes and systolic function, but TA+ group had significantly higher incidence of E/e' > 15, as a marker of severe diastolic dysfunction' (TA+ 23.1% vs. TA- 15.2%; p = 0.050). During average follow-up of 14 ± 5 months, major adverse cardiac/cerebral events occurred at the similar rate (log rank p = 0.867). Thrombus aspiration is associated with a greater incidence of severe diastolic dysfunction in unselected STEMI patients treated with primary PCI, but it doesn't influence the incidence of major adverse cardiovascular events.

Manual Aspiration Thrombectomy in Acute Myocardial Infarction: A Clinical Experience

Multiple clinical studies have failed to establish the role of routine use of thrombectomy in ST-elevation myocardial infarction (STEMI) patients. There is a paucity of data on the impact of thrombectomy in unselected STEMI patients outside clinical trials. We sought to evaluate the clinical variables and outcomes associated with the performance of thrombectomy in STEMI patients. We retrospectively examined the clinical outcomes in all STEMI patients who underwent successful percutaneous intervention (PCI) at our center. Patients were divided into two groups, one with patients who underwent conventional PCI and another with patients who had thrombus aspiration in addition to conventional PCI. We compared the baseline clinical characteristics, laboratory investigations, re-infarction rates, and all-cause mortality. Total 477 consecutive STEMI patients were identified. Overall, 29% (139) of the patients underwent conventional PCI and 71% (338) of the patients were treated with aspiration thrombectomy and PCI. In addition to the presence of thrombus, patients with nonanterior infarction, and patients with hemodynamic instability requiring intra-aortic balloon pump support were more likely to undergo thrombectomy. Thrombectomy was associated with higher enzymatic infarction (creatine kinase: 2,796 [2,575] vs. 1,716 [1,662]; p < 0.0001; CK-MB: 210.6 [156.0] vs. 142.0 [121.9], p < 0.0001). However, thrombectomy was not associated with any difference in 30 day reinfarction rate (3.3 vs. 2.9%, p = 0.83), mortality (5.0 vs. 7.2%, p = 0.35), or composite of death and 30 day reinfarction (7.7 vs. 9.4%, p = 0.55). We observed that STEMI patients with anterior infarction and hemodynamic instability were more likely to undergo thrombectomy during primary PCI.

Abstract 20395: Racial/Ethnic and Gender Disparities in Use of Drug-Eluting vs. Bare Metal Stents in ST-Elevation Myocardial Infarction Patients, 2006-2012

Background: Recent evidence continues to show the benefit of drug-eluting stents (DES) over bare metal stents (BMS) in patient outcomes following ST-elevation myocardial infarction (STEMI), although the use of DES may be contraindicated in patients with specific comorbidities. In this study, we investigated racial/ethnic and gender disparities in the use of DES, after controlling for the effects of age, insurance status, secular trends, and comorbidities. Methods: The study population included all STEMI patients (n=60,218) who received PCI and at least one stent in any Florida acute-care hospital during 2006-2012. Hospital discharge data were analyzed. Procedure codes identified DES (ICD-9-CM 36.07) and BMS (ICD-9-CM 36.06). We used logistic regression to model the odds of receiving a DES. Potential predictors included in the model were patient age, racial/ethnic-gender group (referent=White men), year, payer (referent=commercial), diabetes, atrial fibrillation (AFIB), chronic kidney disease (CKD), and end-stage renal disease (ESRD). Results: Among all STEMI patients, Hispanic women were most likely to receive a DES (61.2%) and Black men were least likely (46.8%). Furthermore, the % of patients who received no stent also varied from 6.7% among Hispanic men to 12.8% among Black women. Multivariable logistic regression results were highly significant, with included independent variables significantly predictive of the odds of receiving a DES in the expected directions. After adjustment and compared with White men, Hispanic women were 24% more likely to receive a DES (OR 1.24, 95%CI 1.13-1.37), White women were 8% more likely to receive a DES (p=0.001), and Black women were 15% less likely to receive a DES (OR 0.85, 95% CI 0.76-0.95). There were no significant differences in DES usage for Hispanic men or for men or women or “other” race/ethnicity. The strongest disparity was observed for Black men, who were 32% less likely to receive a DES than White men (OR 0.68, 95% CI 0.63-0.74, p&lt;0.0001). Conclusions: In this real-world analysis of unselected and recent STEMI patients, a significant disparity in use of DES for Black men and women was observed. This disparity was not explained by patient age, payer or comorbidities, nor by the secular trend.

Abstract 324: Real World Use of Bivalirudin in ST-Elevation Myocardial Infarction is Associated with Lower In-Hospital Complications, 1-Year Major Adverse Cardiac Events and Mortality

Background: Bivalirudin decreased bleeding and improved mortality in ST-elevation myocardial infarction (STEMI) patients undergoing percutaneous coronary intervention (PCI) in the HORIZON trial. Currently there is limited data regarding the benefits of bivalirudin in unselected STEMI patients in real-world clinical practice. Methods: We reviewed consecutive STEMI patients at a large regional STEMI referral center from June 2009 to December 2011. All patients received aspirin and P2Y12 inhibitors. In-hospital complications, length of stay (LOS), total variable costs, 1-year cardiovascular readmissions, major adverse cardiac events (MACE) and mortality were compared for: bivalirudin alone, heparin alone and either medication with IIb/IIIa inhibitors. Results: Among 759 STEMI PCI cases, 208 (27.4%) received bivalirudin, 216 (28.5%) heparin and 335 (44.1%) IIb/IIIa, including only 48 cases with bivalirudin. Bivalirudin alone had significantly lower in-hospital complications, bleeding events, mortality and 1-year MACE and mortality (p&lt;0.05 for all) (Figure). There were no significant differences in LOS (median 2.6 vs. 2.8 vs. 2.9 days; p=0.065), total variable costs (median $9,303 vs. $9,242 vs. $9,860; p=0.15) or readmissions within 1 year. Conclusions: In an unselected population of STEMI patients, those treated with bivalirudin had lower in-hospital complications and lower 1-year MACE and mortality rates compared to patients receiving heparin or IIb/IIIa inhibitors. These results provide further support for bivalirudin use in STEMI patients.

Incidence and clinical impact of concurrent chronic total occlusion according to gender in ST‐Elevation myocardial infarction

To determine the prevalence of a concurrent CTO in men and women and to examine its impact on mortality. The impact of chronic total occlusion (CTO) in patients with ST-elevation myocardial infarction (STEMI) according to gender has not been assessed. Patients referred with STEMI were categorized into single vessel disease (SVD), multivessel disease (MVD) without, with 1 or > 1 CTO. The primary end-point was the 1-year mortality. Among the 2020 STEMI patients included between 2006 and 2011, 24% were female. Women were older, had more hypertension and renal failure (P < 0.0001 for all). The prevalence of 1 or > 1 concurrent CTO was similar in both sexes, 7 and 1%, respectively. Early and late mortality was significantly higher in women compared with men (P < 0.0001). In women, the mortality was significantly worse in patients with > 1 CTO (100%) and with 1 CTO (36.4%) compared with those with MVD without CTO (18.4%) or with SVD (10.4%) (P < 0.0001). MVD with and without concurrent CTO were both independent predictors of 1-year mortality in women (HR 3.58; 95 % CI 1.69-7.18 and HR 2.76; 95 % CI 1.33-5.51) whereas only MVD with CTO was predictive in men (HR 2.19; 95% CI 1.20-3.97). Among unselected STEMI patients, the prevalence of CTO was equal in both sexes whereas early and late mortality remained significantly higher in women. Other factors than the presence of a concurrent CTO must be explored to explain differences in survival after STEMI between women and men.

Impact of transfer time on mortality in acute coronary syndrome with ST-segment elevation treated by angioplasty

In primary percutaneous coronary intervention (pPCI), conflicting data exist on the relative importance of patient presentation time (time from symptom onset (SO) to first medical contact [FMC]) and transfer time (time from FMC to sheath insertion). To evaluate the impact of transfer time on mortality in an unselected ST-elevation myocardial infarction (STEMI) population treated with pPCI. In a well-organized urban network, using mobile intensive care units (MICU) whenever possible, the impact of transfer time on inhospital mortality was evaluated in 703 unselected consecutive STEMI patients transferred for pPCI. Our STEMI population included patients with cardiogenic shock (5.3%) and out-of-hospital cardiac arrest (3.7%). Longer transfer times were found to be associated with a stepwise increase in mortality ranging from 2.99% in the first quartile (Q1) up to 8.65% in the fourth quartile (Q4) (P=0.005). This result was noted in patients presenting early (≤2h of SO, 0.96% for Q1 vs. 9.8% for Q4, P=0.006) but not in late presenters (>2h of SO, 7.00% for Q1 vs. 7.8% for Q4, P=0.85). After adjustment for confounding variables such as the severity of patients, the relationship between mortality and transfer time was no longer apparent. In a well-organized urban network dedicated to pPCI, including unselected STEMI patients, transfer time does not appear to be a major contributor to mortality. The relationship of transfer time to mortality seems to be dependent on presentation time and patients' clinical severity.

Impact of thrombus aspiration during primary percutaneous coronary intervention on mortality in ST-segment elevation myocardial infarction

To assess the impact of thrombus aspiration during primary percutaneous coronary intervention (PPCI) on the mortality of patients with ST-elevation myocardial infarction (STEMI) patients. Retrospective analysis of prospectively collected data on 2567 consecutive PPCI-treated STEMI patients between 2008 and 2011. Cox proportional hazard models and multiple logistic regression analysis were used to adjust for known covariates. Thrombectomy was performed in 1095 patients (42.7%). Post-PPCI thrombolysis in myocardial infarction 3 flow was more frequently achieved in the thrombectomy group [adjusted odds ratio (OR); 1.92, 95% confidence interval (CI): 1.34-2.76, P = 0.0004]. Overall in-hospital and longer term (mean follow-up 9.9 months) mortality rates were 4.5 and 9.0%, respectively. Thrombectomy was associated with a significant reduction in in-hospital (adjusted OR: 0.51, 95% CI: 0.29-0.93, P = 0.027) and longer term mortality [adjusted hazard ratio (HR): 0.69, 95% CI: 0.48-0.96, P = 0.028]. With propensity weighting, the adjusted HR for longer term mortality for thrombectomy was 0.43 (95% CI: 0.19-0.97; P = 0.042). The association between thrombectomy and reduced longer term mortality was only significant in those with a total ischaemic time ≤180min (P = 0.001) but not in patients with a total ischaemic time >180min (P = 0.99). This study of real-world, unselected STEMI patients demonstrates that thrombus aspiration during PPCI is associated with a significant reduction in mortality, especially in those with a short total ischaemic time. These findings support the use of thrombectomy during PPCI in this group of patients.

STEMI mortality in community hospitals versus PCI-capable hospitals: results from a nationwide STEMI network programme

Reports examining local ST elevation myocardial infarction (STEMI) networks focused mainly on percutaneous coronary intervention (PCI)-related time issues and outcomes. To validate the concept of STEMI networks in a real-world context, more data are needed on management and outcome of an unselected community based STEMI population. The current study evaluated reperfusion strategies and in-hospital mortality in 8500 unselected STEMI patients admitted to 47 community hospitals (n=3053) and 25 PCI-capable hospitals (n=5447) in the context of a nationwide STEMI network programme that started in 2007 in Belgium. The distance between the hub and spoke hospitals ranged from 2.2 to 47 km (median 15 km). A propensity score was used to adjust for differences in baseline characteristics. Reperfusion strategy was significantly different with a predominant use of primary PCI (pPCI) in PCI-capable hospitals (93%), compared to a mixed use of pPCI (71%) and thrombolysis (20%) in community hospitals. A door-to-balloon time <120 min was achieved in 83% of community hospitals and in 91% of PCI-capable hospitals (p<0.0001). In-hospital mortality was 7.0% in community hospitals versus 6.7% in PCI-capable hospitals with an adjusted odds ratio of 1.1 (95% confidence interval: 0.8-1.4). Between the periods 2007-2008 and 2009-2010, the pPCI rate in community hospitals increased from 60% to 80%, whereas the proportion of conservatively managed patients decreased from 11.1% to 7.9%. In a STEMI network with >70% use of pPCI, in-hospital mortality was comparable between community hospitals and PCI-capable hospitals. Participation in the STEMI network programme was associated with an increased adherence to reperfusion guidelines over time.

Abstract 249: Primary Ventricular Fibrillation in ST-Elevation Myocardial Infarction Remains the Major Early Complication

Some data from in-hospital cohorts show that Primary Ventricular Fibrillation (pVF) is declining in patients with ST-Elevation Myocardial Infarction (STEMI). Our objective is to assess the current incidence, associated factors and early mortality of pVF in a pre-hospital cohort of STEMI patients. Methods Prospective cohort of unselected STEMI patients cared for by pre-hospital emergency teams in Andalusia. We analyzed the documented pVF episodes either as initial rhythm or as a complication before in-hospital admission. Univariate and multivariate analysis. Results Of 5529 patients included, 412(7.45%) had at least one pVF episode. All patients were treated, 383(92.9%) were admitted and 288(69.9%) were discharged alive. Univariate analysis: pVF patients are: younger (56.7vs64.1,p&lt;0.0001), male (8.2% vs 5.%,p=0.001), no diabetes (4.8% vs 8.5%,p&lt; 0.0001), no hypertension (6.2% vs 8.9%, p&lt;0.0001), no dyslipidemia (5.7% vs 8.5%,p&lt;0.0001), no prior myocardial infarction (5.6% vs 7.7%,p=0.04), shorter interval from onset-symptoms to call-EMS (63.6 vs 169.8,p&lt;0.0001, median in minutes, p&lt;0.0001), larger infarctions (≥5 leads, 7.9% vs 6.3%,p=0.03), hypotension (95.4 vs 125 mmHG,p&lt;0.0001), higher early mortality: on scene (36,3% vs 7%,p&lt;0.0001) and in-hospital(13.5% vs 6.6%,p&lt;0.0001). 1-month and 1-year mortality were not associated to pVF. pVF patients received more rescue PCI (12.6% vs 7.2%,p&lt;0.0001) but no other reperfusion treatments. Multivariate analysis: pVF was associated to younger patients (OR:0.978;CI 0969-0.987,p&lt;0.0001), neither diabetes (OR:1.063;CI 1.150-2.234,p=0.005) nor dyslipidemia (OR:1.429;CI:1.091-1.872,p=0.01), hypotension (OR:0.986;CI 0983-0.989,p&lt;0.0001), shorter interval symptoms (OR:0.998;CI:0997-0.999,p&lt;0.0001) and early mortality (OR:2.390;CI 1.673-3.415,p&lt;0.0001). They receive more rescue-PCI (OR:1.938;CI 1.362-2.759,p&lt;0.0001). Conclusions. The incidence of pVF in STEMI remains high when testing a pre-hospital cohort. It's an early complication, in younger patients without traditional risk factors, with hypotension during the episode and with high early mortality. Nevertheless, after discharge, the prognosis is as good as in no pVF patients.