Presumed arrhythmic death in consecutive survivors of acute myocardial infarction--implications for primary implantable cardioverter defibrillator implantation.
OBJECTIVE
To describe the occurrence of arrhythmic death among survivors of acute myocardial infarction (AMI) and the availability of a primary implantable cardioverter defibrillator (ICD).


METHODS
Consecutive patients who fulfilled the criteria for AMI admitted to the Sahlgrenska University Hospital during 21 months were prospectively followed for 2 years with a focus on echocardiography and mode of death.


RESULTS
Among the 471 patients, for whom information on ejection fraction (EF) was available and who survived the first week, 10 patients died between days 7 and 30 - of whom one had an arrhythmic death. Among the 461 survivors on day 30, 34 patients (7.4%) had an EF of 30% or less. Among these, 24 were judged to be available for ICD implantation, of whom one died an arrhythmic death during follow-up. Among the remaining 10 patients who were excluded from ICD indication because of either high age and/or severe comorbidity, two patients died an arrhythmic death. Among the remaining 427 patients who had an EF greater than 30%, six died an arrhythmic death. Thus, 10 patients, with EF assessed, died an arrhythmic death between day 7 and 2 years after AMI, but only one would have received an ICD according to the Multicenter Automatic Defibrillator Implantation Trial II criteria and clinical judgement.


CONCLUSIONS
Of the 471 consecutive survivors of AMI, 10 (2%) died an arrhythmic death, of whom only one would have received an ICD according to current guidelines and clinical judgement. Predictors of subsequent arrhythmic death after an AMI, useful on a per patient basis, remain an unmet need.
Holmgren
Christina M
CM
Division of Cardiology, Sahlgrenska University Hospital, Göteborg, Sweden. christina.holmgren@vgregion.se
Nyström
Britta M
BM
Karlsson
Thomas K
TK
Herlitz
Johan D
JD
Edvardsson
Nils G
NG
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001145:Arrhythmias, Cardiac / Q000000981:diagnostic imaging / Q000209:etiology / Q000401:mortality* / Q000517:prevention & control; D002423:Cause of Death; D017147:Defibrillators, Implantable; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality* / Q000628:therapy; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D013318:Stroke Volume; D013548:Sweden / Q000453:epidemiology; D013997:Time Factors; D014463:Ultrasonography; D016277:Ventricular Function, Left