In-hospital predictors for primary prevention of sudden death after acute myocardial infarction with cardiac dysfunction.

Abstract

BACKGROUND:

Current guidelines recommend prophylactic defibrillator implantation in patients with acute myocardial infarction (AMI) and left ventricular ejection fraction (LVEF) ≤40 % or LVEF ≤35 % plus heart failure symptoms or inducible ventricular tachyarrhythmias during an electrophysiology study at 40 days after AMI or 90 days after revascularization. In-hospital predictors of sudden cardiac death (SCD) after AMI during the index hospitalization remain unsettled. We sought to examine in-hospital predictors of SCD in patients with AMI and LVEF ≤40 % evaluated during the index hospitalization.

METHODS:

We retrospectively evaluated 441 consecutive patients with AMI and LVEF ≤40 % admitted to our hospital between 2001 and 2014 (77 % male gender; median age: 70 years; median hospitalization length: 23 days). The primary endpoint was a composite of SCD or aborted SCD at ≥30 days after AMI onset (composite arrhythmic event). LVEF and QRS duration (QRSd) on electrocardiography were measured at a median of 12 days and 18 days, respectively.

RESULTS:

During a median follow-up of 7.6 years, the incidence of composite arrhythmic events was 7.3 % (32 of 441 patients). In multivariable analysis, QRSd ≥100 msec (beta-coefficient = 1.54, p = 0.003), LVEF ≤23 % (beta-coefficient = 1.14, p = 0.007), and onset-reperfusion time > 5.5 h (beta-coefficient = 1.16, p = 0.035) were independent predictors of composite arrhythmic events. The combination of these 3 factors was associated with the highest rate of composite arrhythmic events compared with 0-2 factors (p < 0.001).

CONCLUSIONS:

The combination of QRSd ≥100 msec, LVEF ≤23 %, and onset-reperfusion time > 5.5 h during the index hospitalization provides precise risk stratification for SCD in patients early after AMI.

• Authors: Nao Konagai, Yasuhide Asaumi, Shunsuke Murata, Takashi Noda, Satoshi Takeuchi, Masashi Fujino, Satoshi Honda, Shuichi Yoneda, Yu Kataoka, Fumiyuki Otsuka, Kunihiro Nishimura, Kenichi Tsujita, Kengo Kusano, Teruo Noguchi, Satoshi Yasuda
• Journal: Journal of cardiology (J Cardiol) Vol. 82 Issue 3 Pg. 186-193 (09 2023) ISSN: 1876-4738 [Electronic] Netherlands
• PMID: 37187290 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2023 Elsevier Ltd. All rights reserved.

Topics

• Humans
• Male
• Aged
• Female
• Stroke Volume (physiology)
• Retrospective Studies
• Ventricular Function, Left
• Myocardial Infarction (complications, therapy, diagnosis)
• Death, Sudden, Cardiac (epidemiology, etiology, prevention & control)
• Hospitals
• Primary Prevention