title: Sudden cardiovascular death following myocardial infarction: the importance of left ventricular systolic dysfunction and congestive heart failure.
abstract: BACKGROUND
  To study the prognostic information of congestive heart failure (CHF) and left ventricular systolic dysfunction regarding sudden and non-sudden cardiovascular death (SCD and non-SCD) in patients with acute myocardial infarction (MI), as this may indicate the potential benefit of implantable defibrillators.
  
  
  METHODS
  Data from consecutive patients with acute MI screened in 1990-92 for the TRAndolapril Cardiac Evaluation (TRACE) study were entered into a registry. A total of 5502 patients were alive 30 days after the MI and were followed for up to 4 years with respect to cause of death. SCD was defined as cardiovascular death within 1 h of onset of symptoms. An echocardiography was performed 1-6 days after the admission and evaluated centrally using the wall motion index (WMI).
  
  
  RESULTS
  Half of the patients had CHF and 17% of the patients had WMI < or =1.0 (corresponding to an ejection fraction < or =0.30). During follow-up 431 patients died from SCD and 606 from non-SCD. The risk ratios for SCD and non-SCD associated with WMI < or =1.0 were 3.17 and 2.95, transient CHF 2.01 and 1.46, and permanent CHF 3.71 and 4.42, respectively. No risk factor was a specific marker of SCD or non-SCD. The 3-year probability of SCD was 7.9% for patients with transient CHF, 13.3% for permanent CHF, and 15.5% for WMI < or =1.0.
  
  
  CONCLUSIONS
  CHF and low WMI identify a relevant proportion of patients with MI who are at high absolute risk of SCD. This study indicates the relevance of defibrillators in consecutive post-MI patients with left ventricular dysfunction or clinical signs of heart failure.
authors.affiliation: National Institute of Public Health, Øster Farimagsgade 5, DK-1399 Copenhagen, Denmark. stabil@dadlnet.dk
authors.forename: Steen Z
authors.initials: SZ
authors.lastname: Abildstrom
authors.forename: Michael M
authors.initials: MM
authors.lastname: Ottesen
authors.forename: Christian
authors.initials: C
authors.lastname: Rask-Madsen
authors.forename: Per K
authors.initials: PK
authors.lastname: Andersen
authors.forename: Susanne
authors.initials: S
authors.lastname: Rosthøj
authors.forename: Christian
authors.initials: C
authors.lastname: Torp-Pedersen
authors.forename: Lars
authors.initials: L
authors.lastname: Køber
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000627:therapeutic use; D016757:Death, Sudden, Cardiac / Q000453:epidemiology / Q000209:etiology*; D003718:Denmark / Q000453:epidemiology; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000401:mortality* / Q000503:physiopathology / Q000517:prevention & control; D006801:Humans; D007211:Indoles / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000188:drug therapy / Q000401:mortality* / Q000503:physiopathology; D016017:Odds Ratio; D016016:Proportional Hazards Models; D016032:Randomized Controlled Trials as Topic; D012042:Registries; D012307:Risk Factors; D013599:Systole; D018487:Ventricular Dysfunction, Left / Q000401:mortality* / Q000503:physiopathology / Q000517:prevention & control
chemical_list: D000959:Antihypertensive Agents; D007211:Indoles; C052035:trandolapril