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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
  1. Tsuyoshi Shiga (mshiga{at}hij.twmu.ac.jp)
  1. Tokyo Women's Medical University, Japan
    1. Nobuhisa Hagiwara
    1. Tokyo Women's Medical University, Japan
      1. Hiroshi Ogawa
      1. Tokyo Women's Medical University, Japan
        1. Atsushi Takagi
        1. Tokyo Women's Medical University, Japan
          1. Michitaka Nagashima
          1. Tokyo Women's Medical University, Japan
            1. Takao Yamauchi
            1. Tokyo Women's Medical University, Japan
              1. Yukio Tsurumi
              1. Tokyo Women's Medical University, Japan
                1. Ryo Koyanagi
                1. Tokyo Women's Medical University, Japan
                  1. Hiroshi Kasanuki
                  1. Tokyo Women's Medical University, Japan

                    Abstract

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

                    Design: A multicenter observational prospective registered cohort study.

                    Setting: Reduced LVEF is currently the best available predictor of SCD in MI survivors. Early revascularization, such as primary PCI, reduces mortality in acute MI patients.

                    Patients: 4,122 consecutive patients (mean age 66+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 categorized into 3 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: 2.73-13.14, P<0.001, HR 3.37, 95% CI: 1.74-6.50, P<0.001, respectively), and mortality (HR 3.85, 95% CI: 2.96-5.00, P<0.001, HR 1.66, 95% CI: 1.66-2.57, P<0.001, respectively), compared to patients with LVEF>40%. Kaplan-Meier estimates of SCD in our patients with LVEF≤30% were 2.9%, 5.1% and 5.1% at 1, 3 and 5 years, respectively.

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

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