Sudden cardiac death after acute ST elevation myocardial infarction: insight from a developing country
Hygriv B Rao1, B K S Sastry1, Radhika Korabathina1
1Department of Cardiology, CARE Hospitals, Hyderabad, Andhra Pradesh, India.
Insights
Sudden cardiac death (SCD) after ST-elevation myocardial infarction (STEMI) is common in India, with most events occurring within the first month. Key risk factors include age, female gender, severe LV dysfunction, lack of reperfusion/revascularization, and poor medication adherence.
Area of Science:
- Cardiology
- Public Health
Background:
- Sudden cardiac death (SCD) following ST-elevation myocardial infarction (STEMI) lacks comprehensive data in India.
- This study aimed to assess the incidence and influencing factors of SCD post-STEMI.
Purpose of the Study:
- To determine the incidence of sudden cardiac death (SCD) in patients with ST-elevation myocardial infarction (STEMI) in India.
- To identify demographic and clinical factors associated with SCD following STEMI.
Main Methods:
- A prospective database of 929 STEMI patients (2006-2009) was established.
- Follow-up through questionnaires (2010-2011) ascertained survival and cause of death.
Main Results:
- The study included 929 STEMI patients with a mean follow-up of 41 months.
- Of 159 deaths, 78 were SCD. SCD incidence at 1 month, 1, 2, and 3 years was 4.9%, 6.5%, 8.0%, and 8.9%, respectively.
- Multivariate analysis identified age, female gender, severe LV dysfunction, absence of reperfusion/revascularization, and poor medication adherence as significant predictors of SCD.
Conclusions:
- SCD constitutes approximately half of all deaths following STEMI in this Indian cohort.
- SCD predominantly affects a younger population and occurs most frequently within the first month post-STEMI.
- Findings highlight the need for targeted healthcare strategies in India to mitigate SCD risk after STEMI.
Background:
There is no data concerning sudden cardiac death (SCD) following acute ST elevation myocardial infarction (STEMI) in India. We assessed the incidence and factors influencing SCD following STEMI.
Methods:
Patients with STEMI admitted in our hospital from 2006 to 2009 were prospectively entered into a database. In the period 2010-2011, patients or their kin were periodically contacted and administered a questionnaire to ascertain their survival, and mode of death if applicable.
Results:
Study population comprised of 929 patients with STEMI (mean age 55±17 years) having a mean follow-up of 41±16 months. The total number of deaths was 159, of which 78 were SCD (mean age 62.2±10 years). The cumulative incidence of total deaths and SCD at 1 month, 1, 2, 3 years and at conclusion of the study was 10.1%, 13.2%, 14.6%, 15.8%, 17.3% and 4.9%, 6.5%, 8.0%, 8.9% and 9.7%, respectively. The temporal distribution of SCD was 53.9% at first month, 19.2% at 1 month to 1 year, 15.4% in 1-2 years, 7.6% in 2-3 years and 3.8% beyond 3 years. Comparison between SCD and survivor cohorts by multivariate analysis showed five variables were found to be associated with SCD (age p=0.0163, female gender p=0.0042, severe LV dysfunction p=0.0292, absence of both reperfusion and revascularisation p=0.0373 and lack of compliance with medications p <0.0001).
Conclusions:
SCD following STEMI accounts for about half of the total deaths. It involves younger population and most of these occur within the first month. This data has relevance in prioritising healthcare strategies in India.
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