Gaetano M De Ferrari1, Veronica Dusi2, Marta Ruffinazzi2, Lucrezia C Masiello2, Enrico Ruffino3, Luisa Cacciavillani4, Patrizia Noussan5, Valerio Zacà6, Tommaso Sanna7, Marina L Lazzarotti8, Tullio Usmiani9, Massimiliano Gnecchi2, Gianfranco Parati10, Lia Crotti11, Peter J Schwartz12. 1. 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. 2. 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. 3. Department of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy. 4. Division of Cardiology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy. 5. Division of Cardiology, San Giovanni Bosco Hospital, Turin, Italy. 6. Arrhythmology Unit, Cardiovascular and Thoracic Department, AOU Senese, Siena, Italy. 7. Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy. 8. Division of Cardiology, Azienda Socio-Sanitaria Vimercate, Vimercate, Italy. 9. Cardiovascular and Thoracic Department, A.O.U. Città della Salute e della Scienza Ospedale Molinette, Torino, Italy. 10. 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. 11. 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. 12. Istituto Auxologico Italiano, IRCCS, Center for Cardiac Arrhythmias of Genetic Origin, Laboratory of Cardiovascular Genetics, Milan, Italy. Electronic address: peter.schwartz@unipv.it.
Abstract
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.
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.