Sudden cardiac death early after ST elevation myocardial infarction with and without severe left ventricular
Nishad Chitnis1, Sudhindra Vooturi2, B Hygriv Rao3
1Cardiologist, Dept. of Cardiology, Krishna Institute of Medical Sciences, Hyderabad 500003, India.
Insights
Sudden cardiac death (SCD) is common after ST-elevation myocardial infarction (STEMI), especially in patients with preserved left ventricular ejection fraction (LVEF). Early medication compliance is crucial for preventing SCD post-STEMI.
Area of Science:
- Cardiology
- Clinical Medicine
- Public Health
Background:
- Sudden cardiac death (SCD) poses a significant risk in the early period following ST-elevation myocardial infarction (STEMI).
- Left ventricular ejection fraction (LVEF) is a key indicator of cardiac function post-STEMI.
- Understanding temporal patterns and predictors of SCD is crucial for risk stratification and intervention.
Purpose of the Study:
- To compare the temporal patterns of SCD in STEMI patients with LVEF ≤35% versus LVEF >35%.
- To identify predictors of SCD in the early post-STEMI period.
- To inform the development of risk assessment algorithms for SCD.
Main Methods:
- Prospective data collection from STEMI patients.
- Cohort divided into two groups based on LVEF: ≤35% (Group A) and >35% (Group B).
- Analysis of SCD incidence, temporal trends, and multivariate predictors.
Main Results:
- A total of 929 patients were followed for 41 months. Group A had 154 patients (LVEF 29.9%) and Group B had 775 patients (LVEF 49%).
- SCD incidence was higher in Group B (6.8%) compared to Group A (16.2%), but the absolute number of SCD events was greater in Group B.
- Multivariate predictors of SCD included medication compliance in the first month and severe LV dysfunction combined with medication compliance beyond the first month.
Conclusions:
- SCD incidence is high in the first month post-STEMI, regardless of LVEF.
- While Group A had a higher *rate* of SCD, Group B experienced a greater *absolute number* of SCD events.
- There is an urgent need for algorithms to accurately assess SCD risk in the early post-STEMI period.
Introduction:
There is high incidence of SCD in the early period following STEMI. We compared the temporal patterns and predictors of SCD amongst patients with LVEF ≤35% and LVEF >35%.
Methods:
Data from STEMI patients was prospectively collected. SCD cases formed the study cohort and were categorized into 2 groups based on their LV function.
Results:
There were 929 patients (mean age 55 ± 17 years) with a follow up of 41 ± 16 months. 154 pts (16.6%) had LVEF ≤35% (Group A, LVEF-29.9% ± 6%) and 775 pts had LVEF >35% (Group B, LVEF - 49% ± 14%). The two groups were similar with respect to sex distribution, age, prevalence of hypertension, and mean period of presentation. They differed in incidence of anterior wall MI (77.2% vs 55%), reperfusion (69% vs. 75%), prevalence of diabetes (50.6% vs 42%), and medication non-compliance (34% vs. 13%). The total SCD was 78 [Gp A, 25 (16.2%); Gp B, 53 (6.8%); p < 0.001]. The temporal cumulative SCD related mortality in the 2 groups was 1st month (8% vs. 4% p = 0.075), 3 months (14% vs. 5%, p < 0.001), 6 months (17% vs. 5%, p < 0.001), 1 year (18% vs. 6%, p < 0.001), at end of follow up (27% vs. 8%, p < 0.001). Multivariate predictors of SCD were medication compliance in the first month, and severe LV dysfunction with medication compliance beyond 1st month.
Conclusion:
The incidence of SCD is high in first month after STEMI, irrespective of LV function. The number of SCD is higher in Group B patients. Algorithms to assess risk of SCD in early post STEMI period are urgently needed.
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