Determinants of sudden death after discharge from hospital for myocardial infarction in the thrombolytic era

AIMS: The purpose of this study was to assess risk factors for sudden death after discharge from hospital for myocardial infarction in an era in which 50% of patients receive thrombolytic drugs. METHODS AND RESULTS: We prospectively studied 708 consecutive survivors of myocardial infarction admitted to hospitals, which had registered their clinical, functional, and electrical parameters. A total of 83 patients died in the first 2 years (12%) after discharge. Sudden death was only observed in 12 patients. In multivariate analysis only NYHA class >I, and a filtered QRS duration > or =110 ms were important predictive variables for sudden death. A pre-defined high-risk group of 25 patients had no sudden death. When the strongest predictive variables in univariate analysis were combined to increase the positive predictive value for sudden death, we only achieved a maximal value of 27%. CONCLUSIONS: In an unselected infarction population, the risk for sudden death is low in the first 2 years. Therefore, prediction and prophylactic intervention, such as defibrillator therapy become difficult. The event is related to cardiac dysfunction on admission, and with abnormalities in the filtered electrocardiogram.