Sudden death in patients with myocardial infarction and left ventricular dysfunction, heart failure, or both.
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 did so in the first 30 days 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.
Solomon
Scott D
SD
Cardiovascular Division, Brigham and Women's Hospital, Boston, MA 02115, USA. ssolomon@rics.bwh.harvard.edu
Zelenkofske
Steve
S
McMurray
John J V
JJ
Finn
Peter V
PV
Velazquez
Eric
E
Ertl
George
G
Harsanyi
Adam
A
Rouleau
Jean L
JL
Maggioni
Aldo
A
Kober
Lars
L
White
Harvey
H
Van de Werf
Frans
F
Pieper
Karen
K
Califf
Robert M
RM
Pfeffer
Marc A
MA
D000368:Aged; D016757:Death, Sudden, Cardiac / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D006323:Heart Arrest / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D006333:Heart Failure / Q000150:complications*; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000150:complications*; D016032:Randomized Controlled Trials as Topic; D012151:Resuscitation; D012306:Risk; D013318:Stroke Volume; D013997:Time Factors; D018487:Ventricular Dysfunction, Left / Q000150:complications*