Key result
Sudden cardiac death in patients with AMI and HF was less likely to be preceded by non-fatal CV events like MI or HF hospitalization than non-sudden CV death.
Why the study?
In patients with acute myocardial infarction complicated by heart failure or left ventricular systolic dysfunction, the probability of subsequent non-fatal cardiovascular events and sudden cardiac death was explored.
Observational (n=28,771)
In patients with AMI complicated by HF, sudden cardiac death is often not preceded by non-fatal cardiovascular events, highlighting the need for better risk stratification strategies.
Answers are grounded in this paper and cite their sources.
SCD risk peaks early post-AMI with HF and is only modestly preceded by non-fatal events; leaves open targeted prevention strategies in this high-risk window.
AIMS: Among patients with acute myocardial infarction (AMI) complicated by heart failure [HF; clinical HF or left ventricular (LV) systolic dysfunction], we explored the probability of subsequent non-fatal cardiovascular (CV) events and sudden cardiac death (SCD). METHODS AND RESULTS: The high-risk myocardial infarction (HRMI) database contains 28 771 patients with signs of HF or reduced LV ejection fraction (<40%) after AMI. We evaluated the temporal association between SCD with preceding non-fatal CV event [HF hospitalization, recurrent myocardial infarction (MI), or stroke]. Median follow-up was 1.9 years. Mean age was 65.0 ± 11.5 years and 70% were male. The incidence of CV death was 7.9 per 100 patient-years and for SCD was 3.1 per patient-years (40% of CV deaths). The incidence of SCD preceded by HF hospitalization was greater than SCD without preceding HF hospitalization (P < 0.05). However, overall, SCD was less likely to be preceded by a non-fatal CV event compared to other causes of death: 9.6% of SCD events were preceded by an MI (vs. 46.6% for non-sudden CV death); 17.0% of SCD events were preceded with an HF hospitalization (vs. 25.4% for non-sudden CV death); and 2.7% of SCD events were preceded by stroke (vs.12.9% for non-sudden CV death). CONCLUSION: Among patients with AMI complicated by HF, SCD, compared with other causes of death, was less likely to be preceded by a non-fatal CV event. As patients are less likely to have preceding non-fatal CV events to alert the healthcare team of a possible impending SCD event, additional strategies for risk stratification for SCD are needed.
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Hui et al. (2020) conducted an observational in Acute myocardial infarction complicated by heart failure (n=28,771). Preceding non-fatal cardiovascular events vs. Non-sudden cardiovascular death was evaluated on Proportion of sudden cardiac deaths preceded by a non-fatal cardiovascular event compared to non-sudden cardiovascular deaths. Sudden cardiac death in patients with AMI and HF was less likely to be preceded by non-fatal CV events like MI or HF hospitalization than non-sudden CV death.
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