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Sudden death in patients with myocardial infarction and left ventricular dysfunction, heart failure, or both
Scott D Solomon1, Steve Zelenkofske, John J V McMurray
1Cardiovascular Division, Brigham and Women's Hospital, Boston, MA 02115, USA. ssolomon@rics.bwh.harvard.edu
Insights
Sudden cardiac death risk is highest within 30 days post-myocardial infarction for high-risk patients. Early intervention strategies are crucial for survivors with reduced left ventricular function.
Area of Science:
- Cardiology
- Clinical Medicine
- Public Health
Background:
- Survivors of acute myocardial infarction (MI) with reduced left ventricular systolic function face an elevated risk of sudden cardiac death.
- Assessing the temporal patterns of sudden death risk in these high-risk post-MI patients is critical for timely intervention.
Purpose of the Study:
- To evaluate the incidence and timing of sudden death or cardiac arrest with resuscitation in patients post-myocardial infarction.
- To determine the relationship between left ventricular ejection fraction and the risk of sudden cardiac events.
Main Methods:
- A cohort of 14,609 patients with post-myocardial infarction left ventricular dysfunction, heart failure, or both was analyzed.
- The study assessed the incidence and timing of sudden unexpected death or cardiac arrest with resuscitation relative to left ventricular ejection fraction.
Main Results:
- An event (sudden death or cardiac arrest with resuscitation) occurred in 7% of patients (1067/14,609) at a median of 180 days post-MI.
- The highest risk of sudden death was observed within the first 30 days post-MI (1.4% per month), particularly in patients with left ventricular ejection fraction ≤30% (2.3% per month).
- A 5-percentage-point decrease in left ventricular ejection fraction was associated with a 21% increased adjusted risk of sudden death or cardiac arrest within the first 30 days.
Conclusions:
- Sudden death risk is significantly elevated in the initial 30 days following myocardial infarction for patients with left ventricular dysfunction or heart failure.
- Earlier implementation of preventative strategies for sudden death is recommended for selected high-risk post-MI patients.
Background:
The risk of sudden death from cardiac causes is increased among survivors of acute myocardial infarction with reduced left ventricular systolic function. We assessed the risk and time course of sudden death in high-risk patients after myocardial infarction.
Methods:
We studied 14,609 patients with left ventricular dysfunction, heart failure, or both after myocardial infarction to assess the incidence and timing of sudden unexpected death or cardiac arrest with resuscitation in relation to the left ventricular ejection fraction.
Results:
Of 14,609 patients, 1067 (7 percent) had an event a median of 180 days after myocardial infarction: 903 died suddenly, and 164 were resuscitated after cardiac arrest. The risk was highest in the first 30 days after myocardial infarction--1.4 percent per month (95 percent confidence interval, 1.2 to 1.6 percent)--and decreased to 0.14 percent per month (95 percent confidence interval, 0.11 to 0.18 percent) after 2 years. Patients with a left ventricular ejection fraction of 30 percent or less were at highest risk in this early period (rate, 2.3 percent per month; 95 percent confidence interval, 1.8 to 2.8 percent). Nineteen percent of all sudden deaths or episodes of cardiac arrest with resuscitation occurred within the first 30 days after myocardial infarction, and 83 percent of all patients who died suddenly did so in the first 30 days after hospital discharge. Each decrease of 5 percentage points in the left ventricular ejection fraction was associated with a 21 percent adjusted increase in the risk of sudden death or cardiac arrest with resuscitation in the first 30 days.
Conclusions:
The risk of sudden death is highest in the first 30 days after myocardial infarction among patients with left ventricular dysfunction, heart failure, or both. Thus, earlier implementation of strategies for preventing sudden death may be warranted in selected patients.
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