Why the study?
Although larger infarct sizes correlate with higher ventricular fibrillation risk during STEMI, the direct influence of ventricular fibrillation on infarct size remained poorly investigated.
Does ventricular fibrillation prior to reperfusion affect infarct size in STEMI?
Does ventricular fibrillation prior to reperfusion affect infarct size in STEMI?
Ventricular fibrillation prior to STEMI reperfusion is associated with smaller initial infarct size by troponin AUC, but does not reduce long-term infarct scar size.
VF before reperfusion was associated with smaller acute infarct size in STEMI; leaves open effects on scar or outcomes and needs prospective validation.
Ventricular fibrillation (VF)-induced cardiac arrest frequently complicates ST-segment elevation myocardial infarction (STEMI). Although larger infarct sizes (IS) correlate with a higher risk of VF, the influence of VF itself on IS has remained poorly investigated. To address this knowledge gap, we analyzed the effect of VF on IS in patients and two experimental models. From a prospective cohort, 30 STEMI patients with VF were matched 1:2 with STEMI patients without VF on the common determinants of IS. The primary endpoint was IS, assessed using the 48-h area under the curve (AUC) for troponin. We also compared IS in pigs with/without spontaneous VF during STEMI ( n = 15/group), and in an isolated rat heart model of myocardial infarction with/without electrically induced VF ( n = 7/group). After matching, the patient characteristics, including the area at risk (AR), were similar. IS was 33% lower in the VF group compared to the control group (troponin AUC 1.6 [0.5–3.3] 10 6 arbitrary units vs. 2.4 [0.9–4.1] 10 6 arbitrary units; p < 0.05), but infarct scar size (assessed using MRI and ECG) did not differ between the groups at 1 and 6 months. In both experimental models, IS, expressed as a percentage of AR, was lower ( p < 0.05) in the VF group than in the control group. When common determinants of IS are comparable, VF occurring prior to myocardial infarction reperfusion appears to be associated with smaller IS. Nevertheless, this finding, observed under specific experimental conditions and in a highly selected group of patients, was not associated with reduced infarct scar size. Registration (HIBISCUS-STEMI cohort): ClinicalTrials.gov NCT05794022.
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Stevic et al. (2024) studied this question.
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