Out-of-hospital ventricular fibrillation in patients with acute myocardialinfarction - Coronary angiographic determinants

CONCLUSIONS The study intended to compare the acute coronary anatomy of pat ients with acute myocardial infarction (AMI) complicated by our-of-hospital ventricular fibrillation (VF) versus patients with AMI without this compli cation. BACKGROUND More than half of the deaths associated with AMI occur our of th e hospital and within 1 h of symptom onset. The angiographic determinants o f out-of-hospital VF in patients with AMI have not been investigated in det ail. METHODS Acute coronary angiographic findings of 72 consecutive patients wit h AMI complicated by out-of-hospital VF were compared with findings from 14 1 matched patients with AMI II without this complication. RESULTS Patients with an acute occlusion of the left anterior descending co ronary artery (LAD) or left circumflex coronary artery (LCx) had a higher r isk for out-of-hospital VF compared with patients with an acute occlusion o f the right coronary artery (RCA) (odds ratio and 95% confidence interval, respectively, 4.82 [2.35 to 9.92] and 4.92 [2.34 to 10.39]). With regard to extent of coronary artery disease (CAD), the location of the culprit lesio n in the coronary arteries (proximal vs. mid or distal), the flow in the in farct related artery (IRA), the presence or absence of collaterals to the I RA and chronic occlusions, there were no differences between the two groups . CONCLUSIONS Acute myocardial infarction due to occlusion in the left corona ry artery (LCA) is associated with greater risk for out-of-hospital VF comp ared to the RCA. The location of occlusion within LCA (LAD, LCx, proximal o r distal), amount of myocardium at risk for necrosis and extent of CAD are not related to out-of-hospital VF. (C) 1999 by the American College of Card iology.