Risk factors for primary ventricular fibrillation during a first myocardial infarction: Clinical findings from PREDESTINATION (PRimary vEntricular fibrillation and suDden dEath during firST myocardIal iNfArcTION).

Autor: De Ferrari GM; Department of Medical Sciences, University of Torino, Cardiology AOU Città della Salute e della Scienza, Corso Bramante 88, 10126, Torino, Italy; University of Torino, Department of Medical Sciences, Cardiology, AOU Città della Salute e della Scienza, Corso Bramante 88, 10126, Torino, Italy. Electronic address: g.deferrari@smatteo.pv.it., Dusi V; Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Experimental Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Department of Molecular Medicine, Section of Cardiology, University of Pavia, Pavia, Italy., Ruffinazzi M; Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Experimental Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Department of Molecular Medicine, Section of Cardiology, University of Pavia, Pavia, Italy., Masiello LC; Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Experimental Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Department of Molecular Medicine, Section of Cardiology, University of Pavia, Pavia, Italy., Ruffino E; Department of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy., Cacciavillani L; Division of Cardiology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy., Noussan P; Division of Cardiology, San Giovanni Bosco Hospital, Turin, Italy., Zacà V; Arrhythmology Unit, Cardiovascular and Thoracic Department, AOU Senese, Siena, Italy., Sanna T; Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy., Lazzarotti ML; Division of Cardiology, Azienda Socio-Sanitaria Vimercate, Vimercate, Italy., Usmiani T; Cardiovascular and Thoracic Department, A.O.U. Città della Salute e della Scienza Ospedale Molinette, Torino, Italy., Gnecchi M; Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Experimental Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Department of Molecular Medicine, Section of Cardiology, University of Pavia, Pavia, Italy., Parati G; Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital IRCCS Auxologic Italian Institute, Milan, Italy; Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy., Crotti L; Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital IRCCS Auxologic Italian Institute, Milan, Italy; Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy; Istituto Auxologico Italiano, IRCCS, Center for Cardiac Arrhythmias of Genetic Origin, Laboratory of Cardiovascular Genetics, Milan, Italy., Schwartz PJ; Istituto Auxologico Italiano, IRCCS, Center for Cardiac Arrhythmias of Genetic Origin, Laboratory of Cardiovascular Genetics, Milan, Italy. Electronic address: peter.schwartz@unipv.it.
Jazyk: angličtina
Zdroj: International journal of cardiology [Int J Cardiol] 2020 Mar 01; Vol. 302, pp. 164-170. Date of Electronic Publication: 2019 Nov 19.
DOI: 10.1016/j.ijcard.2019.10.060
Abstrakt: Background: Few studies prospectively assessed risk factors for ventricular fibrillation (VF) during a first myocardial infarction (MI). We designed a nation-wide study aiming to identify clinical and genetic characteristics associated with primary VF; and report here about clinical features.
Methods: PREDESTINATION (PRimary vEntricular fibrillation and suDden dEath during a firST myocardIal iNfArcTION) is an Italian case-control, prospective multicentre study. Cases are patients aged 18-80 years with a first MI and at least one VF episodes occurring within 24 h of symptoms onset, before reperfusion. Cases and controls are paired 1: 2 by gender and age (±5 years).
Results: Among 1026 patients enrolled between 2007 and 2017, 970 entered the primary analysis: 375 cases and 595 controls (mean age 59 years, 85% males). Multivariable analysis identified 5 independent predictors of primary VF: systolic blood pressure (OR 0.982, 95% CI: 0.98-0.99 for each mm Hg) and K + levels <3.5 mEq/L at presentation (OR 2.28, 95% CI: 1.6-3.3), family history of sudden death (OR 1.80, 95% CI: 1.1-3.0), physical inactivity (OR 1.73, 95% CI: 1.1-2.8) and anterior MI (OR 1.52, 95% CI: 1.1-2.1). Excluding K + levels obtained after VF, the OR associated with K + levels <3.5 mEq/L was1.99 (95 CI 1.22-3.21).
Conclusions: The present study identified 5 independent predictors of primary VF: familiarity, anterior MI, low systolic blood pressure, physical inactivity and hypokalaemia. Importantly, the last two risk factors are modifiable and, especially in the presence of a family history of sudden death, they should be avoided as much as possible.
(Copyright © 2019. Published by Elsevier B.V.)
Databáze: MEDLINE
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