Factors Associated With and Outcomes After Ventricular Fibrillation Before and During Primary Angioplasty in Patients With ST-Segment Elevation Myocardial Infarction

Jabbari, Reza; Risgaard, Bjarke; Fosbøl, Emil Loldrup; Scheike, Thomas; Philbert, Berit Thornvig; Winkel, Bo Gregers; Chen, Albert; Glinge, Charlotte; Ahtarovski, Kiril Aleksov; Haunsø, Stig; Køber, Lars; Jørgensen, Erik; Pedersen, Frants; Tfelt-Hansen, Jacob; Engstrøm, Thomas

doi:10.1016/j.amjcard.2015.05.037

Cited by 33 publications

(27 citation statements)

References 21 publications

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“…Even if medical contact is established, only 4.3–19.4% of the patients experiencing out-of-hospital cardiac arrest (OHCA) survive the first 30 days (8). In patients with STEMI, 30-days survival decreases from 94% in patients without VF to 79% in those with VF (10). In our own Danish nationwide prospective case-control study, the GEVAMI (GEnetic causes of Ventricular Arrhythmias in patients with first ST-elevation Myocardial Infarction) study, we enrolled 660 consecutive STEMI patients and found 11.6% to develop VF before primary PCI (11).…”

Section: Acute Myocardial Infarction and Sudden Cardiac Deathmentioning

confidence: 99%

Ventricular Arrhythmias in First Acute Myocardial Infarction: Epidemiology, Mechanisms, and Interventions in Large Animal Models

Sattler

Skibsbye

Linz

et al. 2019

Front. Cardiovasc. Med.

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Ventricular arrhythmia and subsequent sudden cardiac death (SCD) due to acute myocardial infarction (AMI) is one of the most frequent causes of death in humans. Lethal ventricular arrhythmias like ventricular fibrillation (VF) prior to hospitalization have been reported to occur in more than 10% of all AMI cases and survival in these patients is poor. Identification of risk factors and mechanisms for VF following AMI as well as implementing new risk stratification models and therapeutic approaches is therefore an important step to reduce mortality in people with high cardiovascular risk. Studying spontaneous VF following AMI in humans is challenging as it often occurs unexpectedly in a low risk subgroup. Large animal models of AMI can help to bridge this knowledge gap and are utilized to investigate occurrence of arrhythmias, involved mechanisms and therapeutic options. Comparable anatomy and physiology allow for this translational approach. Through experimental focus, using state-of-the-art technologies, including refined electrical mapping equipment and novel pharmacological investigations, valuable insights into arrhythmia mechanisms and possible interventions for arrhythmia-induced SCD during the early phase of AMI are now beginning to emerge. This review describes large experimental animal models of AMI with focus on first AMI-associated ventricular arrhythmias. In this context, epidemiology of first AMI, arrhythmogenic mechanisms and various potential therapeutic pharmacological targets will be discussed.

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Section: Acute Myocardial Infarction and Sudden Cardiac Deathmentioning

confidence: 99%

Ventricular Arrhythmias in First Acute Myocardial Infarction: Epidemiology, Mechanisms, and Interventions in Large Animal Models

Sattler

Skibsbye

Linz

et al. 2019

Front. Cardiovasc. Med.

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“…[2] VF is a life-threatening complication and occurs in nearly 12% of patients with first ST-segment elevation myocardial infarction (STEMI). [7,8] Therefore, efforts to improve risk stratification for SCD should in part be based on an understanding of the molecular mechanisms and pathways underlying the occurrence of VF. [9] In the GE netic causes of V entricular A rrhythmias in patients with first ST-elevation M yocardial I nfarction (GEVAMI) study on ethnical Danes[7] and the Dutch AGNES ( A rrhythmia G enetics in the NE therlandS S tudy) study[10] both suggested a possible genetic component to VF since patients with a family history of sudden death among first-degree relatives had significantly higher odds of experiencing VF before primary percutaneous coronary intervention (PPCI).…”

Section: Introductionmentioning

confidence: 99%

A Common Variant in SCN5A and the Risk of Ventricular Fibrillation Caused by First ST-Segment Elevation Myocardial Infarction

et al. 2017

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BackgroundSeveral common genetic variants have been associated with either ventricular fibrillation (VF) or sudden cardiac death (SCD). However, replication efforts have been limited. Therefore, we aimed to analyze whether such variants may contribute to VF caused by first ST-elevation myocardial infarction (STEMI).MethodsWe analyzed 27 single nucleotide polymorphisms (SNP) previously associated with SCD/VF in other cohorts, and examined whether these SNPs were associated with VF caused by first STEMI in the GEnetic causes of Ventricular Arrhythmias in patients with first ST-elevation Myocardial Infarction (GEVAMI) study on ethnical Danes. The GEVAMI study is a prospective case-control study involving 257 cases (STEMI with VF) and 537 controls (STEMI without VF).ResultsOf the 27 candidate SNPs, one SNP (rs11720524) located in intron 1 of SCN5A which was previously associated with SCD was significantly associated with VF caused by first STEMI. The major C-allele of rs11720524 was present in 64% of the cases and the C/C genotype was significantly associated with VF with an odds ratio (OR) of 1.87 (95% CI: 1.12–3.12; P = 0.017). After controlling for clinical differences between cases and controls such as age, sex, family history of sudden death, alcohol consumption, previous atrial fibrillation, statin use, angina, culprit artery, and thrombolysis in myocardial infarction (TIMI) flow, the C/C genotype of rs11720524 was still significantly associated with VF with an OR of 1.9 (95% CI: 1.05–3.43; P = 0.032). Marginal associations with VF were also found for rs9388451 in HEY2 gene. The CC genotype showed an insignificant risk for VF with OR = 1.50 (95% CI: 0.96–2.40; P = 0.070).ConclusionOne common intronic variant in SCN5A suggested an association with VF caused by first STEMI. Further studies into the functional abnormalities associated with the noncoding variant in SCN5A may lead to important insights into predisposition to VF during STEMI.

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“…Consequently, we can hypothesize that a sudden and complete occlusion of a coronary artery without collateral flow supply may lead in healthy young patients to a proarrhythmic state, a bigger infarct size and a worse prognosis. The impact of "young age" on the risk of SCA in the context of STEMI is still a matter of debate however, with controversial results reported so far (5)(6)(7). In the present study, median ages in the SCA and in the non-SCA groups were 57 and 60 [51-73] years, respectively.…”

Section: Editorialmentioning

confidence: 55%

We must identify patients at risk for pre-hospital sudden cardiac arrest at the early phase of myocardial infarction

Montero

Schmidt

2017

J. Thorac. Dis.

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Global coronary heart disease mortality has markedly decreased for the last 4 decades thanks to primary prevention. More than half of the total reduction has been achieved by controlling cardiovascular risk factors (1). Concurrently, effective therapeutic modalities have contributed to reducing further in-hospital fatal events, obtaining a 6-8% reduction (1,2). Meanwhile, out-of-hospital sudden cardiac arrest (SCA) secondary to myocardial infarction remains high, and still represents the majority of all fatal cardiac events (3). Although there is a large amount of literature regarding this sudden and unexpected complication, there is still need for a better understanding of associated risk factors and to identify patients at highest risk for SCA at the pre-hospital phase. Early recognition of the risk of this grim complication could permit a better triage of high-risk patients and consequently improve their outcome.Concerned by the high pre-hospital mortality in STsegment-elevation myocardial infarction (STEMI), Karam et al. have recently performed a landmark study aimed at identifying characteristics of STEMI patients presenting with out-of-hospital SCA (4). Using a prospective population-based design, they included patients from the e-MUST (Evaluation en Médecine d'Urgence des Stratégies Thérapeutiques des infarctus du myocarde) registry between 2006 and 2010, which includes all the out-of-hospital STEMI patients managed by the Emergency Medical Service (EMS) in Paris area. In short, it combines data collected by the EMS dispatch call center and the EMS physician in the field. They included patients that were primarily managed by the EMS, alive at EMS arrival, with typical angina and a STEMI-compatible electrocardiogram (ECG). Pre-hospital SCA was defined as a "sudden and unexpected pulseless event without obvious extracardiac cause occurring before hospital arrival and witnessed by the EMS". Patients with SCA prior to EMS arrival were excluded because of ECG's poor predictive value for STEMI diagnosis after resuscitation.Eight thousand one hundred and twelve STEMI patients {median age [interquartile range]: 60 years, 78% male} were managed by the EMS within 60 [26-165] minutes after pain onset. Four hundred and fiftytwo patients (5.6%) presented EMS-witnessed out-ofhospital SCA, with ventricular tachycardia or ventricular fibrillation as the most frequent initial rhythms (348 patients, 76.9%). Survival in this population was 63.9%, which was significantly lower than reported in the non-SCA population (95.9%). SCA patients with complete data were randomly split into two cohorts, namely a derivation cohort (two thirds of the population) and a validation cohort (one third of the population). From the derivation cohort, pre-hospital risk factors of SCA were Editorial

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Factors Associated With and Outcomes After Ventricular Fibrillation Before and During Primary Angioplasty in Patients With ST-Segment Elevation Myocardial Infarction

Cited by 33 publications

References 21 publications

Ventricular Arrhythmias in First Acute Myocardial Infarction: Epidemiology, Mechanisms, and Interventions in Large Animal Models

Ventricular Arrhythmias in First Acute Myocardial Infarction: Epidemiology, Mechanisms, and Interventions in Large Animal Models

A Common Variant in SCN5A and the Risk of Ventricular Fibrillation Caused by First ST-Segment Elevation Myocardial Infarction

We must identify patients at risk for pre-hospital sudden cardiac arrest at the early phase of myocardial infarction

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