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espite the decrease in overall mortality from coronary artery disease, the number of out-ofhospital deaths from myocardial infarction is in the range of 60% of all infarct related case fatalities. In the general population, it is only 0.5% per year. 2 However, the absolute number in this group is 10 times higher than in the patient population with known SCD risk, reaching more than 300 000 case fatalities per year in the USA. 2 Even renowned cardiologists such as Ronald W Campbell w1 and Jeffry M Isner w2 , who were experts on the topic of arrhythmias and myocardial infarction, suffered SCD. The MONICA (Monitoring trends and determinants in Cardiovascular disease) study reported that of all coronary heart disease (CHD) patients who die within 28 days after onset of chest pain, two thirds die before reaching the hospital. w3 Accordingly, the main task has been to strengthen primary and secondary prevention. w3 This strategy brings about a major challenge: how can we define who is at risk?
Erbel et al. (Wed,) studied this question.
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