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Incidence and predictors of sudden cardiac death in patients with reduced left ventricular ejection fraction after myocardial infarction in an era of revascularisation
  1. XiaoHan Fan1,
  2. Wei Hua1,
  3. YiZhou Xu2,
  4. Ligang Ding1,
  5. Hongxia Niu1,
  6. Keping Chen1,
  7. Bo Xu1,
  8. Shu Zhang1
  1. 1State Key Laboratory of Cardiovascular Disease, Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
  2. 2Department of Cardiology, Hangzhou First People's Hospital and Hangzhou Hospital of Nanjing Medical University, Hangzhou, China
  1. Correspondence to Dr Wei Hua, Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Beijing 100037, China; drhua{at}vip.sina.com

Abstract

Objective To determine the incidence and predictors of sudden cardiac death (SCD) in the current era of revascularisation of myocardial infarction (MI) survivors with reduced LVEF.

Methods A prospective observational study was conducted in FuWai Hospital from 2004 to 2009. A total of 1018 consecutive patients who had an LVEF ≤35% and New York Heart Association Class II/III heart failure at least 40 days after MI were enrolled if they were not available for implantation of an implantable cardioverter defibrillator. The degree of coronary artery disease and revascularisation were analysed. The primary outcome was SCD and secondary outcome was all-cause death.

Results During a mean follow-up of 2.8 years, the SCD rate was 5% and all-cause mortality was 7.4%. The annual incidence of SCD was 1.8%. Kaplan–Meier analysis showed that the cumulative rate of SCD was significantly increased in patients with triple-vessel disease (6.7% vs 0.6%), left main coronary disease (10.3% vs 4.1%), EF ≤25% (8.3% vs 3.9%) and non-revascularisation therapy (9.6% vs 2.7%) (all log-rank, p<0.05). After multivariable Cox regression analysis, the risk of SCD was predicted by age (HR 1.05, 95% CI 1.02 to 1.09), EF ≤25% (HR 1.82, 95% CI 1.04 to 3.21) and non-revascularisation (HR 3.97, 95% CI 2.15 to 7.31).

Conclusions Revascularisation may reduce the risk of SCD in post-MI patients with an LVEF ≤35% on the basis of medical therapy, and the increased risk for SCD may be predicted by age, LVEF ≤25% and non-revascularisation.

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