Key result
A low left ventricular ejection fraction (≤30%) was the strongest independent predictor of adverse arrhythmic events in Korean post-myocardial infarction patients (OR 7.783).
Why the study?
Do non-invasive parameters including LVEF ≤30%, PVCs ≥10/hr, and NSVT predict sudden cardiac death or adverse arrhythmic events in Korean post-myocardial infarction patients?
Cohort (n=640)
No
Do non-invasive parameters including LVEF ≤30%, PVCs ≥10/hr, and NSVT predict sudden cardiac death or adverse arrhythmic events in Korean post-myocardial infarction patients?
MADIT II criteria (LVEF ≤30%) and ambulatory ECG parameters (PVCs ≥10/hr, NSVT) are useful for predicting adverse arrhythmic events and indicating ICD implantation in Korean post-MI patients, while beta-blocker use is associated with fewer events.
LVEF ≤30% may aid arrhythmic risk stratification in Korean post-MI patients; hypothesis-generating and should not yet change ICD practice.
Background and Objectives:According to the MADIT II criteria, a low left ventricular ejection fraction (LVEF) is one of the most important predicting factors for sudden cardiac death (SCD) in post myocardial infarction (PMI) patients, and it is a reasonable indication for ICD implantation. The aim of this study is to reveal the incidence and the prognostic value of the non-invasive parameters and whether the MADIT II criteria for ICD implantation can be applied to Korean PMI patients. Subjects and Methods:During the period from January 2001 to June 2005, 640 PMI survivors were included in this study. The incidence of an abnormal SAECG, premature ventricular complex (PVC) counts ≥10/hr, non-sustained ventricular tachycardia (NSVT) on ambulatory ECG and a low (≤30%) LVEF were studied and used as risk stratification markers for later adverse arrhythmic events. Results:The incidence of PVCs ≥10/hr and NSVT on the ambulatory ECG was 14.3% and 7.5%, respectively. 29 patients (4.9%) had a LVEF of less than 30%. Arrhythmic events occurred in 9 of the 29 patients (31%). SCD or adverse arrhythmic events occurred in 42 of the 640 patients. The percentage of patients who were using β-blocker was lower than that in the MADIT II study group (55% vs 70%, respectively). In the adverse arrhythmic event (+) group, the percentage of β-blocker use was significantly lower than that in the arrhythmic event (-) group (32.5% vs 58%, respectively). Conclusion:The MADIT II criteria and PVCs ≥10/hr or NSVT on the ambulatory ECG can be suggested as the indications for implanting an ICD in Korean PMI patients. The use of β-blocker is important for preventing adverse arrhythmic events. (Korean Circulation J 2006;36:431-436)
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Sohn et al. (2006) conducted a cohort in Post myocardial infarction (n=640). Low left ventricular ejection fraction (≤30%) vs. LVEF >30% was evaluated on Adverse arrhythmic events (including sudden cardiac death) (OR 7.783, 95% CI 2.587-23.416, p=<0.001). A low left ventricular ejection fraction (≤30%) was the strongest independent predictor of adverse arrhythmic events in Korean post-myocardial infarction patients (OR 7.783).
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