Ventricular fibrillation in acute myocardial infarction in Spanish patients: Results of the ARIAM database

• Published in: Critical care medicine Vol. 31; no. 8; pp. 2144 - 2151
• Main Authors: Ruiz-Bailén, Manuel, Aguayo de Hoyos, Eduardo, Ruiz-Navarro, Silvia, Issa-Khozouz, Ziad, Reina-Toral, Antonio, Ángel Díaz-Castellanos, Miguel, Rodríguez-García, Juan-José, Miguel Torres-Ruiz, Juan, Cárdenas-Cruz, Antonio, Camacho-Víctor, Ángel
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins, Inc 01-08-2003; Lippincott
• Subjects: Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; APACHE; Biological and medical sciences; Cohort Studies; Emergency and intensive cardiocirculatory care. Cardiogenic shock. Coronary intensive care; Female; Hospital Mortality; Humans; Intensive care medicine; Intensive Care Units; Male; Medical Records; Medical sciences; Multivariate Analysis; Myocardial Infarction - complications; Myocardial Infarction - pathology; Odds Ratio; Patient Admission; Prognosis; Registries; Retrospective Studies; Spain - epidemiology; Ventricular Fibrillation - epidemiology; Ventricular Fibrillation - etiology; Ventricular Fibrillation - mortality; Europe; Spain; Human; Intensive care; Prognosis; Arrhythmia; Infarct; Cardiovascular disease; Coronary heart disease; Myocardial disease; cardiac arrest; Excitability disorder; Ventricular fibrillation; Heart disease; Myocardium; thrombolysis; ventricular fibrillation mortality; Complication; acute myocardial infarction
• ISSN: 0090-3493; 1530-0293
• DOI: 10.1097/01.CCM.0000079602.14851.EB

OBJECTIVEThe aim of this study has been to investigate the factors predisposing to primary or secondary ventricular fibrillation (VF) and the prognosis in Spanish patients with acute myocardial infarction (AMI) during their admission to the intensive care unit or the coronary care unit.
DESIGNA retrospective, observational study.
SETTINGThe intensive care units and coronary care units of 119 Spanish hospitals.
PATIENTSA retrospective cohort study including all the AMI patients listed in the ARIAM registry (Analysis of Delay in Acute Myocardial Infarction), a Spanish multicenter study. The study period was January 1995 to January 2001.
MEASUREMENTS AND MAIN RESULTSFactors associated with the onset of VF were studied by univariate analysis. Multivariate analysis was used to evaluate the independent factors for the onset of VF and for mortality. A total of 17,761 patients with AMI were included in the study; 964 (5.4%) developed VF (primary in 735 patients, secondary in 229). In multivariate analysis, the variables that continued to show an association with the development of VF were the Killip and Kimball class, peak creatine kinase, APACHE II score, age, and time from the onset of symptoms to the initiation of thrombolysis. The mortality in the patients with any VF was 31.8% (27.8% in patients with primary VF and 49.1% in patients with secondary VF). The development of VF is an independent predictive factor for mortality in patients with AMI, with a crude odds ratio of 5.12 (95% confidence interval, 4.41–5.95) and an adjusted odds ratio of 2.73 (95% confidence interval, 2.12–3.51).
CONCLUSIONSDespite the considerable improvement in the treatment of AMI in recent years, the onset of either primary or secondary VF is associated with a poor prognosis. It is usually accompanied by extensive necrosis.