Incidence and risk factors of ventricular fibrillation before primary angioplasty in patients with first ST-elevation myocardial infarction: a nationwide study in Denmark

Reza Jabbari; Thomas Engstrøm; Charlotte Glinge; Bjarke Risgaard; Javad Jabbari; Bo Gregers Winkel; Christian Juhl Terkelsen; Hans-Henrik Tilsted; Lisette Okkels Jensen; Mikkel Hougaard; Stephanie E Chiuve; Frants Pedersen; Jesper Hastrup Svendsen; Stig Haunsø; Christine M Albert; Jacob Tfelt-Hansen

doi:10.1161/JAHA.114.001399

Incidence and risk factors of ventricular fibrillation before primary angioplasty in patients with first ST-elevation myocardial infarction: a nationwide study in Denmark

J Am Heart Assoc. 2015 Jan 5;4(1):e001399. doi: 10.1161/JAHA.114.001399.

Authors

Reza Jabbari¹, Thomas Engstrøm², Charlotte Glinge¹, Bjarke Risgaard¹, Javad Jabbari¹, Bo Gregers Winkel¹, Christian Juhl Terkelsen³, Hans-Henrik Tilsted⁴, Lisette Okkels Jensen⁵, Mikkel Hougaard⁵, Stephanie E Chiuve⁶, Frants Pedersen⁷, Jesper Hastrup Svendsen⁸, Stig Haunsø⁸, Christine M Albert⁶, Jacob Tfelt-Hansen⁸

Affiliations

¹ 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.).
² 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.).
³ Department of Cardiology, Aarhus University Hospital in Skejby, Aarhus, Denmark (C.J.T.).
⁴ Department of Cardiology, Aalborg University Hospital, Copenhagen, Denmark (H.H.T.).
⁵ Department of Cardiology, Odense University Hospital, Denmark (L.O.J., M.H.).
⁶ 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.).
⁷ 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.).
⁸ 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.).

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.

Methods and 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.

Conclusion: 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.

Keywords: myocardial infarction; sudden death; ventricular fibrillation.

Publication types

Comparative Study
Multicenter Study
Research Support, Non-U.S. Gov't

MeSH terms

Age Distribution
Aged
Alcohol Drinking / epidemiology
Angioplasty, Balloon, Coronary / methods*
Angioplasty, Balloon, Coronary / mortality
Case-Control Studies
Death, Sudden, Cardiac / epidemiology*
Denmark
Electrocardiography / methods
Female
Humans
Incidence
Life Style*
Logistic Models
Male
Middle Aged
Myocardial Infarction / diagnosis*
Myocardial Infarction / epidemiology
Myocardial Infarction / therapy
Prospective Studies
Risk Factors
Severity of Illness Index
Sex Distribution
Smoking / epidemiology
Statistics, Nonparametric
Treatment Outcome
Ventricular Fibrillation / diagnosis
Ventricular Fibrillation / epidemiology*