Early risk predictors of sudden cardiac death after myocardial infarction: Results of follow up of 881 patients

INTRODUCTION: It has been shown that depolarization disorders, autonomic dysfunction, and systolic dysfunction of the left ventricle are associated with sudden cardiac death after myocardial infarction. OBJECTIVE: The objective of study was to examine the prognostic value of the most important predictors in the first week after myocardial infarction. METHOD: Study included 881 patients who were followed up from 1 to 60 months. During the first week after myocardial infarction, following examination were performed: ECG with standard leads and X, Y, Z orthogonal leads, vectorcardiogram, QT interval, late potentials, short-time spectral analysis of RR variability, nonlinear (Poincaré plot) analysis and echocardiogram. RESULTS: In univariate analysis, the following parameters measured on the first day were important predictors of sudden cardiac death: lower LF/HF ratio (<1.5) (p = 0.000), T wave inversion in X lead (p = 0.000), high P wave in D2 lead (p=0.030), and diminished systolic function (p = 0.000). In multivariate analysis, the following parameters were significant risk predictors: T wave inversion in X lead, lower LF/HF ratio, positive late potentials and the left ventricle systolic dysfunction. CONCLUSION: The parameters of the left ventricle systolic disfunction with sympathicovagal imbalance and electric instability are the key risk predictors in the first few days after myocardial infarction.