PROGNOSIS OF EARLY VERSUS LATE VENTRICULAR-FIBRILLATION COMPLICATING ACUTE MYOCARDIAL-INFARCTION

Earlier studies have suggested that patients exhibiting late (> 24 h) ventricular fibrillation during acute myocardial infarction had a poor er outcome in comparison to myocardial infarction patients with early (< 24 h) ventricular fibrillation. Between August 1981 and July 1983, 5839 consecutive patients with acute myocardial infarction were hospit alized in 13 out of 21 operating coronary care units in Israel. Demogr aphic and medical data were collected from hospitalization charts and during 1 year of follow-up. Mortality assessment was done for 99%, of hospital survivors up to mid-1988 (mean, 5.5 years). The incidence of ventricular fibrillation in the SPRINT Registry was 6%, (371/5839). Pa tients with ventricular fibrillation in the setting of cardiogenic sho ck (n = 107) were excluded from analysis. Patients with late ventricul ar fibrillation (n = 109; 41%) were older and had a more complicated h ospital course than patients with early ventricular fibrillation (n = 155; 59%). In-hospital and 1-year post-discharge mortality were signif icantly higher in patients with late ventricular fibrillation (63% and 17%) as compared to patients with early ventricular fibrillation (26% and 4%, respectively; P < 0.05 for each). This difference vanished 5 years after hospital discharge. After multiple logistic regression ana lysis late occurrence of ventricular fibrillation emerged as an indepe ndent predictor of increased in-hospital mortality (Odds ratio, 4.29; 95% confidence interval, 2.11-8.74) but not for subsequent death. Pati ents with late ventricular fibrillation during the hospital course of acute myocardial infarction had a poorer immediate and subsequent outc ome in comparison to patients with early ventricular fibrillation.