title: Left ventricular systolic dysfunction, total mortality, and sudden death in patients with myocardial infarction treated with n-3 polyunsaturated fatty acids.
abstract: BACKGROUND
  Sudden death (SD) has a major impact on mortality (M) in patients with left ventricular systolic dysfunction (SyD). In GISSI-Prevenzione, treatment with n-3 polyunsaturated fatty acids (PUFA) reduced M and SD in post-MI patients, but their effect in patients with SyD is unknown.
  
  
  METHODS
  11,323 patients with prior MI and NYHA class < or = II were recruited. After excluding patients with no ejection fraction (EF) measurement (1684), and those with missing data (n=9), 9630 patients were available for analysis. Multivariate Cox regression adjusted models were fitted.
  
  
  RESULTS
  Compared to patients with EF > 50%, SyD patients had higher M (12.3% vs. 6.0%) and SD (3.4% vs. 1.4%) rates. PUFA reduced M similarly in patients with (RR 0.76 (0.60-0.96) P=0.02) and without SyD (RR 0.81 (0.59-1.10) P=0.17) (heterogeneity tests P=0.55). In contrast, the effect on SD was markedly asymmetrical: PUFA produced a marked reduction (RR 0.42 (0.26-0.67) P=0.0003) of risk in SyD patients whereas the effect was less evident (RR 0.89 (0.41-1.69) P=0.71) in patients with EF > 50% (heterogeneity tests P=0.07). There was a significant increase in SD with worsening EF (P test for trend=0.02), the benefit on SD in patients with EF < or = 40% being 4-fold higher than in those with EF > 50%.
  
  
  CONCLUSIONS
  Increasing SyD is associated with elevated risk of SD and with increasing benefit from PUFA. The effect of PUFA on SD reduction was greater in patients with SyD. Prospective trials testing the effect of PUFA in populations with SyD are required.
authors.affiliation: Consorzio Mario Negri Sud, Santa Maria Imbaro, Chieti, Italy.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Macchia
authors.forename: Giacomo
authors.initials: G
authors.lastname: Levantesi
authors.forename: Maria Grazia
authors.initials: MG
authors.lastname: Franzosi
authors.forename: Enrico
authors.initials: E
authors.lastname: Geraci
authors.forename: Aldo Pietro
authors.initials: AP
authors.lastname: Maggioni
authors.forename: RosaMaria
authors.initials: R
authors.lastname: Marfisi
authors.forename: Gian Luigi
authors.initials: GL
authors.lastname: Nicolosi
authors.forename: Carlo
authors.initials: C
authors.lastname: Schweiger
authors.forename: Luigi
authors.initials: L
authors.lastname: Tavazzi
authors.forename: Gianni
authors.initials: G
authors.lastname: Tognoni
authors.forename: Franco
authors.initials: F
authors.lastname: Valagussa
authors.forename: Roberto
authors.initials: R
authors.lastname: Marchioli
mesh_terms: D000368:Aged; D015897:Comorbidity; D016757:Death, Sudden, Cardiac / Q000517:prevention & control*; D015525:Fatty Acids, Omega-3 / Q000494:pharmacology / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000453:epidemiology / Q000401:mortality; D018487:Ventricular Dysfunction, Left / Q000188:drug therapy* / Q000453:epidemiology / Q000401:mortality
chemical_list: D015525:Fatty Acids, Omega-3