[Sudden death among 1,000 patients with myocardial infarction: incidence and contributory factors. KYSMI Study Group]

Clinical indicators and the incidence of sudden death among 1,000 consecutive patients (816 males and 184 females) with myocardial infarction were investigated between 1983 and 1987 after coronary arteriography. Twenty-four patients died suddenly during a study period of 3.3 +/- 2.0 yrs. The yearly incidence of sudden death calculated by the Kaplan-Meier method was 0.7%, nearly half of the incidence of cardiac death (1.5%/yr). Univariate analysis demonstrated statistically significant differences in the number of cases with coronary thrombolysis in the acute phase, degree of coronary artery stenosis, the frequency and degree of congestive heart failure and angina in the acute and chronic phase, the presence of serious post-infarction arrhythmia, ejection fraction, recurrent myocardial infarction, and administration of digitalis and diuretics. between the sudden-death group and the cardiac and other patient groups. There was also a tendency to higher frequency of history of diabetes mellitus, presence of acute mitral regurgitation, nitrates and nicorandil treatment, and coronary artery bypass graft in the sudden-death group. Multivariate analysis revealed that digitalis and nitrates treatment and left anterior descending artery involvement were major contributing factors. Re-infarction, left ventricular ejection fraction, and nicorandil therapy were not significant and minor contributing factors. The incidence of sudden death increased with digitalis therapy (Odds' ratio of 9.59), and left anterior descending artery disease, and decreased with nitrates (0.34).