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Published Online First: 26 August 2008. doi:10.1136/hrt.2008.145243
Heart 2009;95:216-220
Copyright © 2009 BMJ Publishing Group Ltd & British Cardiovascular Society

ORIGINAL ARTICLES

Sudden cardiac death and left ventricular ejection fraction during long-term follow-up after acute myocardial infarction in the primary percutaneous coronary intervention era: results from the HIJAMI-II registry

T Shiga, N Hagiwara, H Ogawa, A Takagi, M Nagashima, T Yamauchi, Y Tsurumi, R Koyanagi, H Kasanuki, for the Heart Institute of Japan Acute Myocardial Infarction-II (HIJAMI-II) Investigators

Department of Cardiology, Tokyo Women’s Medical University, Tokyo, Japan

Dr Tsuyoshi Shiga, Department of Cardiology, Tokyo Women’s Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan; mshiga{at}hij.twmu.ac.jp

Objective: To determine the incidence of sudden cardiac death (SCD) according to left ventricular ejection fraction (LVEF) in survivors of myocardial infarction (MI) in the primary percutaneous coronary intervention (PCI) era.

Design: A multicentre observational prospective registered cohort study.

Setting: 18 medical centres in Japan.

Patients: 4122 consecutive patients (mean age 66 (SD 12) years, 73.7% male) with acute MI, who were discharged alive.

Main outcome measures: The primary end-point was SCD, and a secondary end-point was death from any cause.

Results: Patients were categorised into three groups: LVEF >40% (n = 3416), LVEF <=40% and >30% (n = 507) and LVEF <=30% (n = 199). Among all patients, 77.8% received PCI and 3.7% received coronary artery bypass graft surgery. During an average follow-up of 4.1 years, SCD was 1.2% and mortality was 13.1%. Patients with LVEF <=30% and LVEF <=40% and >30% were at increased risk for SCD (HR 5.99, 95% CI 2.73 to 13.14, p<0.001, HR 3.37, 95% CI 1.74 to 6.50, p<0.001, respectively), and mortality (HR 3.85, 95% CI 2.96 to 5.00, p<0.001, HR 2.06, 95% CI 1.66 to 2.57, p<0.001, respectively), compared to patients with LVEF >40%. Kaplan-Meier estimates of SCD in patients with LVEF <=30% were 2.9%, 5.1% and 5.1% at 1, 3 and 5 years, respectively.

Conclusion: There is a low incidence of SCD in survivors of MI in the primary PCI era, although LVEF is a predictor of increased risk for SCD.


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