RT Journal Article
SR Electronic
T1 Incidence and predictors of sudden cardiac death in patients with reduced left ventricular ejection fraction after myocardial infarction in an era of revascularisation
JF Heart
JO Heart
FD BMJ Publishing Group Ltd and British Cardiovascular Society
SP 1242
OP 1249
DO 10.1136/heartjnl-2013-305144
VO 100
IS 16
A1 XiaoHan Fan
A1 Wei Hua
A1 YiZhou Xu
A1 Ligang Ding
A1 Hongxia Niu
A1 Keping Chen
A1 Bo Xu
A1 Shu Zhang
YR 2014
UL http://heart.bmj.com/content/100/16/1242.abstract
AB 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.