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Impact of the angiographic burden on the incidence of out-of-hospital ventricular fibrillation in patients with acute myocardial infarction

  • Yoichiro Sugizaki
  • Toshiro Shinke
  • Tomohumi Doi
  • Nobuaki Igarashi
  • Hiromasa Otake
  • Hiroyuki Kawamori
  • Ken-ichi Hirata
Original Article

Abstract

Ventricular fibrillation (VF) is a catastrophic complication of spontaneous (type 1) acute myocardial infarction (AMI). This study sought to clarify the angiographic coronary characteristics related to out-of-hospital VF in AMI patients. We retrospectively reviewed 464 consecutive cases of suspicious AMI, including type 1 AMI, with or without out-of-hospital VF. In addition to patient demographics, proximal left coronary artery (LCA) disease, multivessel disease (MVD), and chronic total occlusion (CTO) were assessed via coronary angiography and compared between patients with and without out-of-hospital VF. Coronary angiography was evaluated for 74 patients with out-of-hospital VF and for 237 without. Male sex (93.2 vs. 83.1%; P = 0.036), Killip class ≥ 2 (89.2 vs. 16.5%; P < 0.001), and ST elevation myocardial infarction (83.8 vs. 66.7%; P = 0.003) were more frequent in the out-of-hospital VF group. The culprit lesions located in the proximal left coronary artery (62.2 vs. 29.5%; P < 0.001), MVD (75.7 vs. 41.8%, P < 0.001), and CTO (43.2 vs. 10.5%, P < 0.001) were more frequently observed in patients with out-of-hospital VF. Multivariate logistic regression analysis identified the culprit lesion located in the proximal LCA [odds ratio (OR) 2.86; 95% confidence interval (CI) 1.34–6.08], the presence of CTO (OR 8.52; 95% CI 3.35–21.65), and MVD (OR 3.69; 95% CI 1.57–8.65) as predictors of out-of-hospital VF. For type 1 AMI patients, advanced disease burden including the culprit lesion located in the proximal LCA and coexistence of CTO or MVD might be associated with out-of-hospital VF.

Keywords

Acute myocardial infarction Chronic total occlusion Multivessel disease Out-of-hospital ventricular fibrillation 

Abbreviations

AMI

Acute myocardial infarction

CAG

Coronary angiography

CIs

Confidence intervals

CTO

Chronic total occlusion

ECPR

Extracorporeal cardiopulmonary resuscitation

LCA

Left coronary artery

LMT

Left main trunk

LVEF

Left ventricular ejection fraction

MI

Myocardial infarction

MVD

Multivessel disease

OHCA

Out-of-hospital cardiac arrest

OR

Odds ratio

PCI

Percutaneous coronary intervention

ROSC

Return of spontaneous circulation

STEMI

ST elevation myocardial infarction

VF

Ventricular fibrillation

Notes

Funding

This work had no funding support.

Compliance with ethical standards

Conflicts of interest

The authors have no conflicts of interest directly relevant to the content of this article.

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Copyright information

© Springer Japan KK, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Division of Cardiovascular Medicine, Department of Internal MedicineKobe University Graduate School of MedicineKobeJapan
  2. 2.Department of Cardiovascular MedicineKobe Red-cross HospitalKobeJapan
  3. 3.Department of Cardiovascular MedicineHyogo Emergency Medical CenterKobeJapan

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