Sudden Death in Patients with Myocardial Infarction and Left Ventricular Dysfunction, Heart Failure, or Both
Scott D. Solomon, M.D., Steve Zelenkofske, D.O., John J.V. McMurray, M.D., Peter V. Finn, M.D., Eric Velazquez, M.D., George Ertl, M.D., Adam Harsanyi, M.D., Jean L. Rouleau, M.D., Aldo Maggioni, M.D., Lars Kober, M.D., Harvey White, D.Sc., Frans Van de Werf, M.D., Ph.D., Karen Pieper, M.S., Robert M. Califf, M.D., Marc A. Pfeffer, M.D., Ph.D., for the Valsartan in Acute Myocardial Infarction Trial (VALIANT) Investigators
Background The risk of sudden death from cardiac causes is increasedamong survivors of acute myocardial infarction with reducedleft ventricular systolic function. We assessed the risk andtime course of sudden death in high-risk patients after myocardialinfarction.
Methods We studied 14,609 patients with left ventricular dysfunction,heart failure, or both after myocardial infarction to assessthe incidence and timing of sudden unexpected death or cardiacarrest with resuscitation in relation to the left ventricularejection fraction.
Results Of 14,609 patients, 1067 (7 percent) had an event amedian of 180 days after myocardial infarction: 903 died suddenly,and 164 were resuscitated after cardiac arrest. The risk washighest in the first 30 days after myocardial infarction —1.4 percent per month (95 percent confidence interval, 1.2 to1.6 percent) — and decreased to 0.14 percent per month(95 percent confidence interval, 0.11 to 0.18 percent) after2 years. Patients with a left ventricular ejection fractionof 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 orepisodes of cardiac arrest with resuscitation occurred withinthe first 30 days after myocardial infarction, and 83 percentof all patients who died suddenly did so in the first 30 daysafter hospital discharge. Each decrease of 5 percentage pointsin the left ventricular ejection fraction was associated witha 21 percent adjusted increase in the risk of sudden death orcardiac arrest with resuscitation in the first 30 days.
Conclusions The risk of sudden death is highest in the first30 days after myocardial infarction among patients with leftventricular dysfunction, heart failure, or both. Thus, earlierimplementation of strategies for preventing sudden death maybe warranted in selected patients.
Source Information
From the Cardiovascular Division, Brigham and Women's Hospital, Boston (S.D.S., P.V.F., M.A.P.); Novartis Pharmaceuticals, East Hanover, N.J. (S.Z.); the Department of Cardiology, Western Infirmary, Glasgow, Scotland (J.J.V.M.); Duke University Medical Center, Durham, N.C. (E.V., K.P., R.M.C.); University of Wurzburg, Wurzburg, Germany (G.E.); the National Center for Health Services, Budapest, Hungary (A.H.); the University of Montreal, Montreal Heart Institute, Montreal (J.L.R.); Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence, Italy (A.M.); the Department of Cardiology, Rigshospitalet, Copenhagen (L.K.); the Department of Cardiology, Green Lane Hospital, Auckland, New Zealand (H.W.); and Leuven Coordinating Center, Leuven, Belgium (F.V.W.).
Address reprint requests to Dr. Solomon at the Cardiovascular Division, Brigham and Women's Hospital, 75 Francis St., Boston, MA 02115, or at ssolomon{at}rics.bwh.harvard.edu.
Sudden Death in Patients with Myocardial Infarction
Pitt B., the EPHESUS Investigators , Zijlstra F., van der Horst I. C.C., Khera A., Levine B. D., Jacobs A. G., Solomon S. D., Califf R. M., Pfeffer M. A., the VALIANT Investigators , Buxton A. E.
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N Engl J Med 2005;
353:1294-1297, Sep 22, 2005.
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