Sudden cardiac death after acute ST elevation myocardial infarction: insight from a developing country.
BACKGROUND
There is no data concerning sudden cardiac death (SCD) following acute ST elevation myocardial infarction (STEMI) in India. We assessed the incidence and factors influencing SCD following STEMI.


METHODS
Patients with STEMI admitted in our hospital from 2006 to 2009 were prospectively entered into a database. In the period 2010-2011, patients or their kin were periodically contacted and administered a questionnaire to ascertain their survival, and mode of death if applicable.


RESULTS
Study population comprised of 929 patients with STEMI (mean age 55±17 years) having a mean follow-up of 41±16 months. The total number of deaths was 159, of which 78 were SCD (mean age 62.2±10 years). The cumulative incidence of total deaths and SCD at 1 month, 1, 2, 3 years and at conclusion of the study was 10.1%, 13.2%, 14.6%, 15.8%, 17.3% and 4.9%, 6.5%, 8.0%, 8.9% and 9.7%, respectively. The temporal distribution of SCD was 53.9% at first month, 19.2% at 1 month to 1 year, 15.4% in 1-2 years, 7.6% in 2-3 years and 3.8% beyond 3 years. Comparison between SCD and survivor cohorts by multivariate analysis showed five variables were found to be associated with SCD (age p=0.0163, female gender p=0.0042, severe LV dysfunction p=0.0292, absence of both reperfusion and revascularisation p=0.0373 and lack of compliance with medications p <0.0001).


CONCLUSIONS
SCD following STEMI accounts for about half of the total deaths. It involves younger population and most of these occur within the first month. This data has relevance in prioritising healthcare strategies in India.
Department of Cardiology, CARE Hospitals, Hyderabad, Andhra Pradesh, India.
Hygriv B
HB
Rao
Department of Cardiology, CARE Hospitals, Hyderabad, Andhra Pradesh, India.
B K S
BK
Sastry
Department of Cardiology, CARE Hospitals, Hyderabad, Andhra Pradesh, India.
Radhika
R
Korabathina
Department of Cardiology, CARE Hospitals, Hyderabad, Andhra Pradesh, India.
Krishnam P
KP
Raju
India; Sudden cardiac death; arrhythmias; atrial fibrillation; developing country; epidemiology; mortality; myocardial infarction