AIMS: To determine whether predictors of sudden cardiac death (SCD) vary with time after myocardial infarction (MI). METHODS AND RESULTS: We analysed 11 256 patients enrolled in VALIANT. Landmark analysis and Cox proportional hazards modelling were used to predict SCD during hospitalization, from discharge to 30 days, 30 days to 6 months, and 6 months to 3 years. The cumulative incidence of SCD was 8.6% (n = 965). Initially, higher baseline heart rate [HR 1.20 per 10 b.p.m. (95% CI 1.06-1.37)] and impaired baseline creatinine clearance [HR 0.82 per 10 mL/min (95% CI 0.74-0.91)] were stronger predictors of SCD. With long-term follow-up, prior MI [HR 1.71 (95% CI 1.39-2.10)], initial left ventricular ejection fraction <40% [HR 0.67 per 10% (95% CI 0.58-0.78)], and recurrent cardiovascular events [HR 1.47 for rehospitalization (95% CI 1.17-1.86)] were more robust risk stratifiers for SCD. Atrial fibrillation post-MI was associated with an increased risk of SCD over the entire follow-up period. As time passed, the associations between baseline clinical characteristics and SCD decreased and time-updated assessments became more important. CONCLUSION: Predictors of SCD change with time after MI. Future studies of risk stratification for SCD should account for changes in these factors with time after MI.
RCT Entities:
AIMS: To determine whether predictors of sudden cardiac death (SCD) vary with time after myocardial infarction (MI). METHODS AND RESULTS: We analysed 11 256 patients enrolled in VALIANT. Landmark analysis and Cox proportional hazards modelling were used to predict SCD during hospitalization, from discharge to 30 days, 30 days to 6 months, and 6 months to 3 years. The cumulative incidence of SCD was 8.6% (n = 965). Initially, higher baseline heart rate [HR 1.20 per 10 b.p.m. (95% CI 1.06-1.37)] and impaired baseline creatinine clearance [HR 0.82 per 10 mL/min (95% CI 0.74-0.91)] were stronger predictors of SCD. With long-term follow-up, prior MI [HR 1.71 (95% CI 1.39-2.10)], initial left ventricular ejection fraction <40% [HR 0.67 per 10% (95% CI 0.58-0.78)], and recurrent cardiovascular events [HR 1.47 for rehospitalization (95% CI 1.17-1.86)] were more robust risk stratifiers for SCD. Atrial fibrillation post-MI was associated with an increased risk of SCD over the entire follow-up period. As time passed, the associations between baseline clinical characteristics and SCD decreased and time-updated assessments became more important. CONCLUSION: Predictors of SCD change with time after MI. Future studies of risk stratification for SCD should account for changes in these factors with time after MI.
Authors: Paul L Hess; Amy Laird; Rex Edwards; Gust H Bardy; J Thomas Bigger; Alfred E Buxton; Arthur J Moss; Kerry L Lee; W J Hall; Richard Steinman; Paul Dorian; Al Hallstrom; Riccardo Cappato; Alan H Kadish; Peter J Kudenchuk; Daniel B Mark; Sana M Al-Khatib; Jonathan P Piccini; Lurdes Y T Inoue; Gillian D Sanders Journal: Heart Rhythm Date: 2013-02-13 Impact factor: 6.343
Authors: Mohamed Moussa Arisha; Nicolas Girerd; Samuel Chauveau; Didier Bresson; Alina Scridon; Eric Bonnefoy; Philippe Chevalier Journal: Ann Noninvasive Electrocardiol Date: 2013-10-23 Impact factor: 1.468