Impact of late ventricular fibrillation on postdischarge 1-year mortality of patients presenting with acute myocardial infarction: a nationwide retrospective study

1. Late ventricular fibrillation after acute myocardial infarction is associated with a markedly increased risk of 1-year mortality among patients who survive to hospital discharge.

2. This excess mortality risk is significant in ST-segment elevation myocardial infarction but not clearly demonstrated in non-ST-segment elevation myocardial infarction.

Evidence Rating Level: 2 (Good)

Late ventricular fibrillation, defined as ventricular fibrillation occurring more than 48 hours after acute myocardial infarction, is uncommon in the contemporary reperfusion era, but its prognostic significance after hospital discharge remains uncertain. This nationwide retrospective cohort study used data from the Israeli Acute Coronary Syndrome Survey between 2000 and 2018 to evaluate the incidence of late in-hospital ventricular fibrillation and its association with 1-year mortality among patients with acute myocardial infarction who survived the index hospitalization. Among 14,280 patients with ST-segment elevation and non-ST-segment elevation myocardial infarction admitted to cardiac intensive care units, 118 patients developed late ventricular fibrillation, of whom 68 survived to discharge. Patients with late ventricular fibrillation had more severe clinical profiles, including higher Killip class, lower left ventricular ejection fraction, and more frequent cardiogenic shock and acute renal failure. Overall, 1-year mortality was substantially higher in patients with late ventricular fibrillation compared with those without. After multivariable adjustment, late ventricular fibrillation was independently associated with increased 1-year mortality, with this association remaining statistically significant in patients with ST-segment elevation myocardial infarction but not in those with non-ST-segment elevation myocardial infarction. These findings suggest that late ventricular fibrillation identifies a particularly high-risk subgroup of myocardial infarction survivors, especially among ST-segment elevation myocardial infarction patients, and highlight the need for improved post-discharge risk stratification and evaluation of preventive strategies.

Click here to read the study in BMJ Open

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