Risk factors associated with ventricular fibrillation during first ST-elevation myocardial infarction: Individual participant data analysis of 3 prospective case-control studies

Background: Most of sudden cardiac death in the adult population is caused by ventricular fibrillation (VF) in the setting of acute myocardial ischemia. The assessment of risk factors for VF in this setting may point to novel causal pathways or new targets for intervention and risk prediction of sudden cardiac death. Objective: This study aimed to evaluate the effect of family history of sudden death (SD), history of atrial fibrillation (AF), and anterior infarct location on the electrocardiogram on the development of VF during the first ST-elevation myocardial infarction (STEMI). Methods: We performed an individual participant data meta-analysis of 3 European case-control studies including patients with a first STEMI (aged 18–80 years) with VF (cases) or without VF (controls) before revascularization. Results: We included 1807 cases and 2923 controls (median age 59 years, 20% women) in the analyses. After adjusting for potential confounding, we found an independent association between the 3 risk factors and VF: family history of SD (odds ratio [OR] 1.61, 95% confidence interval 1.38–1.87), previous AF (OR 1.95, 1.22–3.11), and anterior myocardial infarction (OR 1.55, 1.36–1.75). Further investigation indicated increased effect of family history with multiple SDs in the family, a stronger effect of AF on VF developing within the first minutes of symptoms, and the effect of anterior infarctions being modified by enzymatically determined infarct size. Conclusion: Family history of SD, history of AF, and anterior infarct location were all independently and additively associated with an increased risk of VF in patients with a first STEMI.