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Higher Risk of Sudden Death After Myocardial Infarction Among Patients with Left Ventricular Dysfunction or Heart Failure

June 29, 2005

By Sahar Bedrood B.S. and Asher Kimchi M.D.

Boston, MA - One of the most concerning complications of an acute myocardial infarction (MI) is sudden death. The risk of sudden death is greatest within a few hours after MI and decreases dramatically thereafter. Scott D. Solomon, M.D., et al from the Brigham and Women’s Hospital in Boston, MA studied the incidence and timing of sudden unexpected deaths or cardiac arrests after MI in patients with left ventricular dysfunction, heart failure or both. Their study, published in the June 23, 2005 issue of The New England Journal of Medicine shows that the risk of sudden death is highest in the first 30 days after myocardial infarction among patients with left ventricular dysfunction, heart failure or both.  

Though the risk of sudden death after MI is believed to increase, then decrease rapidly, the extent and time course of this change is risk have not been well studied until the Valsartan in Acute Myocardial Infarction Trial (VALIANT) study was set forth by Solomon et al. VALIANT was a randomized controlled study with valsartan, captopril or both in 14,703 patients with a first or subsequent acute myocardial infarction complicated by heart failure, left ventricular systolic dysfunction or both. All patients had an ejection fraction of no more than 40 percent or radiologic evidence of heart failure complicating their myocardial infarction.  

Of 14, 609 patients, 1067 (7 percent) had an event a median of 180 days after MI: 903 died suddenly and 164 were resuscitated after cardiac arrest. The risk was highest in the first 30 days after myocardial infarction –1.4 percent per month (95 percent confidence interval, 1.2 to 1.6 percent) and decreased to 0.14 percent per month after 2 years (95 percent confidence, 0.11 to 0.18 percent). Patients with a left ventricular ejection fraction of 30 percent or less were at highest risk in this early period (rate, 2.3 percent per month; 95 percent confidence interval 1.8 to 2.8 percent). Nineteen percent of all sudden deaths or episodes of cardiac arrest with resuscitation occurred within the first 30 days after myocardial infarction, and 83 percent of all patients who died suddenly did so in the first 30 days after hospital discharge. Each decrease of 5 percentage points in the left ventricular ejection fraction was associated with a 21 percent adjusted increased in the risk of sudden death or cardiac arrest with resuscitation in the first 30 days.  

The results of the analysis made by the VALIANT study confirms that patients with left ventricular dysfunction, heart failure or both are at higher risk for sudden death or cardiac arrest with resuscitations after myocardial infarction. The risk is greatest in the early time period after myocardial infarctions and among patients with the lowest ejection fraction and declines over time. It may be beneficial to consider early intervention strategies in patients who are at an increased risk of sudden death.  

Co-authors: Steve Zelenkofske, D.O., John J.V. McMurray, M.D., Peter V. Finn, M.D., Eric Velazquez, M.D., Geroge Ertl, M.D., Adam Harsanyi, M.D., Jean L. Rouleau, M.D., Aldo Maggioni, M.D., Lars Kober, M.D., Harvey White, D.Sc., Frans Van de Werf, M.D., Ph.D., Karen Pieper, M.D., Robert M. Califf, M.D., and Marc A., Pfeffer, M.D., Ph.D. 


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