Predictors of sudden cardiac death change with time after myocardial infarction: results from the VALIANT trial.
OBJECTIVE
To determine whether predictors of sudden cardiac death (SCD) vary with time after myocardial infarction (MI).


RESULTS
We analysed 11 256 patients enrolled in VALIANT. Landmark analysis and Cox proportional hazards modelling were used to predict SCD during hospitalization, from discharge to 30 days, 30 days to 6 months, and 6 months to 3 years. The cumulative incidence of SCD was 8.6% (n = 965). Initially, higher baseline heart rate [HR 1.20 per 10 b.p.m. (95% CI 1.06-1.37)] and impaired baseline creatinine clearance [HR 0.82 per 10 mL/min (95% CI 0.74-0.91)] were stronger predictors of SCD. With long-term follow-up, prior MI [HR 1.71 (95% CI 1.39-2.10)], initial left ventricular ejection fraction <40% [HR 0.67 per 10% (95% CI 0.58-0.78)], and recurrent cardiovascular events [HR 1.47 for rehospitalization (95% CI 1.17-1.86)] were more robust risk stratifiers for SCD. Atrial fibrillation post-MI was associated with an increased risk of SCD over the entire follow-up period. As time passed, the associations between baseline clinical characteristics and SCD decreased and time-updated assessments became more important.


CONCLUSIONS
Predictors of SCD change with time after MI. Future studies of risk stratification for SCD should account for changes in these factors with time after MI.
Division of Cardiology, Duke Clinical Research Institute, Duke University Medical Center, Durham, NC 27705, USA. jonathan.piccini@duke.edu
Jonathan P
JP
Piccini
Min
M
Zhang
Karen
K
Pieper
Scott D
SD
Solomon
Sana M
SM
Al-Khatib
Frans
F
Van de Werf
Marc A
MA
Pfeffer
John J V
JJ
McMurray
Robert M
RM
Califf
Eric J
EJ
Velazquez
D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D002216:Captopril / Q000627:therapeutic use; D016757:Death, Sudden, Cardiac / Q000209:etiology*; D004311:Double-Blind Method; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000503:physiopathology; D016016:Proportional Hazards Models; D012008:Recurrence; D012307:Risk Factors; D013318:Stroke Volume / Q000502:physiology; D013777:Tetrazoles / Q000627:therapeutic use; D013997:Time Factors; D014633:Valine / Q000031:analogs & derivatives / Q000627:therapeutic use; D000068756:Valsartan; D018487:Ventricular Dysfunction, Left / Q000209:etiology
D000806:Angiotensin-Converting Enzyme Inhibitors; D013777:Tetrazoles; D000068756:Valsartan; D002216:Captopril; D014633:Valine