title: Sudden cardiac death early after ST elevation myocardial infarction with and without severe left ventricular dysfunction.
abstract: BACKGROUND
  There is high incidence of SCD in the early period following STEMI. We compared the temporal patterns and predictors of SCD amongst patients with LVEF ≤35% and LVEF >35%.
  
  
  METHODS
  Data from STEMI patients was prospectively collected. SCD cases formed the study cohort and were categorized into 2 groups based on their LV function.
  
  
  RESULTS
  There were 929 patients (mean age 55 ± 17 years) with a follow up of 41 ± 16 months. 154 pts (16.6%) had LVEF ≤35% (Group A, LVEF-29.9% ± 6%) and 775 pts had LVEF >35% (Group B, LVEF - 49% ± 14%). The two groups were similar with respect to sex distribution, age, prevalence of hypertension, and mean period of presentation. They differed in incidence of anterior wall MI (77.2% vs 55%), reperfusion (69% vs. 75%), prevalence of diabetes (50.6% vs 42%), and medication non-compliance (34% vs. 13%). The total SCD was 78 [Gp A, 25 (16.2%); Gp B, 53 (6.8%); p < 0.001]. The temporal cumulative SCD related mortality in the 2 groups was 1st month (8% vs. 4% p = 0.075), 3 months (14% vs. 5%, p < 0.001), 6 months (17% vs. 5%, p < 0.001), 1 year (18% vs. 6%, p < 0.001), at end of follow up (27% vs. 8%, p < 0.001). Multivariate predictors of SCD were medication compliance in the first month, and severe LV dysfunction with medication compliance beyond 1st month.
  
  
  CONCLUSIONS
  The incidence of SCD is high in first month after STEMI, irrespective of LV function. The number of SCD is higher in Group B patients. Algorithms to assess risk of SCD in early post STEMI period are urgently needed.
authors: Cardiologist, Dept. of Cardiology, Krishna Institute of Medical Sciences, Hyderabad 500003, India.
authors: Nishad
authors: N
authors: Chitnis
authors: Physiotherapist and Statistician, Dept. of Physiotherapy, Krishna Institute of Medical Sciences, Hyderabad 500003, India.
authors: Sudhindra
authors: S
authors: Vooturi
authors: Director Pacing & Electrophysiology, Dept. of Cardiology, Krishna Institute of Medical Sciences, Hyderabad 500003, India. Electronic address: hygriv@hotmail.com.
authors: B
authors: B
authors: Hygriv Rao
mesh_terms: D016757:Death, Sudden, Cardiac / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D006801:Humans; D015994:Incidence; D007194:India / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications* / Q000453:epidemiology; D011446:Prospective Studies; D012307:Risk Factors; D018487:Ventricular Dysfunction, Left / Q000150:complications* / Q000453:epidemiology
keywords: First month; India; LV dysfunction; STEMI; Sudden cardiac death
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