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A correction has been published: N Engl J Med 2005;353(7):744.

Original Article
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Volume 352:2581-2588 June 23, 2005 Number 25
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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

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ABSTRACT

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 in the first 30 days did so 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.


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.

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Related Letters:

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. Correspondence

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