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Article Dans Une Revue European Heart Journal Année : 2022

Ventricular fibrillation in acute myocardial infarction: 20-year trends in the FAST-MI study

Frédéric Anselme
Olivier Césari
Jean Ferrières
Tabassome Simon

Résumé

Aims: Sudden cardiac arrest remains a major complication of acute myocardial infarction (AMI) and is frequently related to ventricular fibrillation (VF). Incidence and impact of VF among patients hospitalized for AMI were evaluated. Methods and results: Data from the FAST-MI programme consisting of 5 French nationwide prospective cohort studies between 1995 and 2015 were analysed, totally including 14 423 patients with AMI (66 ± 14 years, 72% males, 59% ST-elevation myocardial infarction). Overall, proportion of patients presenting in-hospital VF decreased from 3.9% in 1995 to 1.8% in 2015 (P < 0.001). One-year mortality decreased from 60.7% to 24.6% (P < 0.001). However, compared with patients who did not develop VF, the over-risk of 1-year mortality associated with VF was stable over time [hazard ratio (HR) 6.78, 95% confidence interval (CI) 5.03-9.14 in 1995 and HR 6.64, 95% CI 4.20-10.49 in 2015, P = 0.52]. This increased mortality in the VF group was mainly related to fatal events occurring prior to hospital discharge, representing 86.2% of 1-year mortality, despite the very low rate of implantable cardioverter defibrillator in the VF group (2.6%). Conclusion: This study demonstrates that in-hospital VF incidence and mortality in the setting of AMI have significantly decreased over the past 20 years. Nevertheless, VF remained steadily associated with approximately a 10-fold increased relative risk of in-hospital mortality, without an impact on post-discharge mortality. Beyond long-term cardiac defibrillation strategy, these results emphasize the need to identify in-hospital interventions to further reduce mortality in VF patients.
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Dates et versions

hal-04468109 , version 1 (20-02-2024)

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Rodrigue Garcia, Eloi Marijon, Nicole Karam, Kumar Narayanan, Frédéric Anselme, et al.. Ventricular fibrillation in acute myocardial infarction: 20-year trends in the FAST-MI study. European Heart Journal, 2022, 43 (47), pp.4887-4896. ⟨10.1093/eurheartj/ehac579⟩. ⟨hal-04468109⟩
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