Prognostic implications of ventricular fibrillation in acute myocardial infarction: new strategies required for further mortality reduction

Objective-To determine the changing risk of ventricular fibrillation, the p rognostic implications, and the potential long term prognostic benefit of e arlier hospital admission, after acute myocardial infarction. Design-Prospe ctive observational study. Setting-A district general hospital in east Lond on. Patients-1225 consecutive patients admitted to a coronary care unit wit h acute myocardial infarction. Main outcome measures-Time of onset of pain and ventricular fibrillation, and long term survival of patients admitted w ith acute myocardial infarction. Results-The rate of ventricular fibrillati on in these hospital inpatients was high in the first hour from onset of pa in (118 events/1000 persons/h; 95% confidence interval (CI) 50.7 to 391) an d fell rapidly to an almost constant low level by six hours; 27.4% of patie nts with early ventricular fibrillation died in hospital, compared with 11. 6% of those without (p < 0.0001), but mortality in patients who survived to hospital discharge was not altered by early ventricular fibrillation (five year survival: 75.0% (95% CI 60.00% to 84.8%) with ventricular fibrillatio n a 73.3% (95% CT 69.6% to 76.6%) without ventricular fibrillation). Conclu sions-Patients successfully resuscitated from early ventricular fibrillatio n have the same prognosis as those without ventricular fibrillation after a cute myocardial infarction. Faster access to facilities for resuscitation m ust be achieved if major improvements in the persistently high case fatalit y of patients after acute myocardial infarction are to be made. Heart 2000; 84:258-261)