Prognosis after cardiac arrest due to ventricular tachycardia or ventricular fibrillation associated with acute myocardial infarction (The MILIS study)

Geoffrey H. Tofler, Peter H. Stone, James E. Muller, John D. Rutherford, Stefan N. Willich, Nancy F. Gustafson, W. Kenneth Poole, Burton E. Sobel, James T. Willerson, Thomas Robertson, Eugene Passamani, Eugene Braunwald

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Abstract

Previous studies have reached conflicting conclusions about whether cardiac arrest due to ventricular tachycardia (VT) or ventricular fibrillation (VF) in acute myocardial infarction (AMI) is of long-term prognostic significance. The mortality rate in 849 patients with confirmed AMI was analyzed. The mortality rate during the initial hospitalization was higher for patients in whom VT/VF occurred (27 vs 7%, p <0.001). The in-hospital mortality rate for patients with primary VT/VF, that is, VT/VF occurring in the absence of hypotension or heart failure, was similar to that of patients who did not have VT/VF (8 % vs 7 %, difference not significant), whereas the rate for patients with secondary VT/VF was significantly greater than that for patients with no VT/VF (51 % vs 7%, p <0.001). The timing of occurrence of VT/VF also influenced mortality: Patients in whom VT/VF occurred more than 72 hours after admission had a higher in-hospital mortality rate than did patients in whom it occurred within 72 hours (57 % vs 20 %, p <0.05). All cases of primary VT/VF occurred within the first 72 hours of admission. The long-term mortality rate for hospital survivors was not significantly different for patients who had had VT/VF during acute infarction compared with those who had not (19 % vs 21 % ) (mean follow-up 32 months). Thus, cardiac arrest due to ventricular tachyarrhythmia was associated with a higher in-hospital mortality rate but was not a prognostic factor among hospital survivors. Patients resuscitated from primary VT/VF, which characteristically occurs early after AMI, do not have an adverse prognosis.

Original languageEnglish (US)
Pages (from-to)755-761
Number of pages7
JournalThe American Journal of Cardiology
Volume60
Issue number10
DOIs
StatePublished - Oct 1 1987

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Ventricular Fibrillation
Ventricular Tachycardia
Heart Arrest
Myocardial Infarction
Mortality
Hospital Mortality
Survivors
Tachycardia
Hypotension
Infarction
Hospitalization
Heart Failure

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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Prognosis after cardiac arrest due to ventricular tachycardia or ventricular fibrillation associated with acute myocardial infarction (The MILIS study). / Tofler, Geoffrey H.; Stone, Peter H.; Muller, James E.; Rutherford, John D.; Willich, Stefan N.; Gustafson, Nancy F.; Kenneth Poole, W.; Sobel, Burton E.; Willerson, James T.; Robertson, Thomas; Passamani, Eugene; Braunwald, Eugene.

In: The American Journal of Cardiology, Vol. 60, No. 10, 01.10.1987, p. 755-761.

Research output: Contribution to journalArticle

Tofler, GH, Stone, PH, Muller, JE, Rutherford, JD, Willich, SN, Gustafson, NF, Kenneth Poole, W, Sobel, BE, Willerson, JT, Robertson, T, Passamani, E & Braunwald, E 1987, 'Prognosis after cardiac arrest due to ventricular tachycardia or ventricular fibrillation associated with acute myocardial infarction (The MILIS study)', The American Journal of Cardiology, vol. 60, no. 10, pp. 755-761. https://doi.org/10.1016/0002-9149(87)91018-6
Tofler, Geoffrey H. ; Stone, Peter H. ; Muller, James E. ; Rutherford, John D. ; Willich, Stefan N. ; Gustafson, Nancy F. ; Kenneth Poole, W. ; Sobel, Burton E. ; Willerson, James T. ; Robertson, Thomas ; Passamani, Eugene ; Braunwald, Eugene. / Prognosis after cardiac arrest due to ventricular tachycardia or ventricular fibrillation associated with acute myocardial infarction (The MILIS study). In: The American Journal of Cardiology. 1987 ; Vol. 60, No. 10. pp. 755-761.
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AU - Tofler, Geoffrey H.

AU - Stone, Peter H.

AU - Muller, James E.

AU - Rutherford, John D.

AU - Willich, Stefan N.

AU - Gustafson, Nancy F.

AU - Kenneth Poole, W.

AU - Sobel, Burton E.

AU - Willerson, James T.

AU - Robertson, Thomas

AU - Passamani, Eugene

AU - Braunwald, Eugene

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N2 - Previous studies have reached conflicting conclusions about whether cardiac arrest due to ventricular tachycardia (VT) or ventricular fibrillation (VF) in acute myocardial infarction (AMI) is of long-term prognostic significance. The mortality rate in 849 patients with confirmed AMI was analyzed. The mortality rate during the initial hospitalization was higher for patients in whom VT/VF occurred (27 vs 7%, p <0.001). The in-hospital mortality rate for patients with primary VT/VF, that is, VT/VF occurring in the absence of hypotension or heart failure, was similar to that of patients who did not have VT/VF (8 % vs 7 %, difference not significant), whereas the rate for patients with secondary VT/VF was significantly greater than that for patients with no VT/VF (51 % vs 7%, p <0.001). The timing of occurrence of VT/VF also influenced mortality: Patients in whom VT/VF occurred more than 72 hours after admission had a higher in-hospital mortality rate than did patients in whom it occurred within 72 hours (57 % vs 20 %, p <0.05). All cases of primary VT/VF occurred within the first 72 hours of admission. The long-term mortality rate for hospital survivors was not significantly different for patients who had had VT/VF during acute infarction compared with those who had not (19 % vs 21 % ) (mean follow-up 32 months). Thus, cardiac arrest due to ventricular tachyarrhythmia was associated with a higher in-hospital mortality rate but was not a prognostic factor among hospital survivors. Patients resuscitated from primary VT/VF, which characteristically occurs early after AMI, do not have an adverse prognosis.

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