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CLINICAL STUDIES

Out-of-hospital ventricular fibrillation in patients with acute myocardial infarction

Coronary angiographic determinants

Peter J. Gheeraert, MD^*, José P. S. Henriques, MD, Marc L. De Buyzere, MSc^*, Joeri Voet, MD^*, Pol Calle, MD, PhD, Yves Taeymans, MD, PhD^* and Felix Zijlstra, MD, PhD

^* Department of Cardiology, University Hospital, Gent, Belgium
Department of Emergency Medicine, University Hospital, Gent, Belgium
the Department of Cardiology, De Weezenlanden Hospital, Zwolle, the Netherlands

Manuscript received September 29, 1998; revised manuscript received July 27, 1999, accepted September 13, 1999.

Reprint requests and correspondence: Dr. Peter Gheeraert, Department of Cardiology, University Hospital, De Pintelaan 185, B-9000 Ghent, Belgium
peter.gheeraert{at}rug.ac.be

OBJECTIVES

The study intended to compare the acute coronary anatomy of patients with acute myocardial infarction (AMI) complicated by out-of-hospital ventricular fibrillation (VF) versus patients with AMI without this complication.

BACKGROUND

More than half of the deaths associated with AMI occur out of the hospital and within 1 h of symptom onset. The angiographic determinants of out-of-hospital VF in patients with AMI have not been investigated in detail.

METHODS

Acute coronary angiographic findings of 72 consecutive patients with AMI complicated by out-of-hospital VF were compared with findings from 144 matched patients with AMI without this complication.

RESULTS

Patients with an acute occlusion of the left anterior descending coronary artery (LAD) or left circumflex coronary artery (LCx) had a higher risk for out-of-hospital VF compared with patients with an acute occlusion of 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 lesion in the coronary arteries (proximal vs. mid or distal), the flow in the infarct related artery (IRA), the presence or absence of collaterals to the IRA and chronic occlusions, there were no differences between the two groups.

CONCLUSIONS

Acute myocardial infarction due to occlusion in the left coronary artery (LCA) is associated with greater risk for out-of-hospital VF compared to the RCA. The location of occlusion within LCA (LAD, LCx, proximal or distal), amount of myocardium at risk for necrosis and extent of CAD are not related to out-of-hospital VF.

Abbreviations and Acronyms   AMI = acute myocardial infarction   CAD = coronary artery disease   IRA = infarct-related coronary artery   JS = jeopardy score (= amount of myocardium in "jeopardy")   LAD = left anterior descending coronary artery   LCA = left coronary artery   LCx = left circumflex coronary artery   LVEF = left ventricular ejection fraction   RCA = right coronary artery   TIMI = Thrombolysis in Myocardial Infarction   VF = ventricular fibrillation

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