Risk factors for sudden death after acute myocardial infarction: Two-year follow-up

Mukharji, Jhulan; Rude, Robert E.; Poole, W. Kenneth; Gustafson, Nancy; Thomas, Lewis J.; Strausś, H. William; Jaffe, Allan S.; Muller, James E.; Roberts, Robert; Raabe, Daniel S.; Croft, Charles H.; Passamani, Eugene R.; Braunwald, Eugene; Willerson, James T.

doi:10.1016/0002-9149(84)90299-6

Cited by 522 publications

(100 citation statements)

References 35 publications

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“…Long-term follow-up of MI survivors conducted in the 1970s and 1980s indicated that the greatest risk of sudden death was in the initial 6 to 12 months after infarction, particularly in high-risk subgroups such as those with impaired ventricular function. [1][2][3][4] However, therapeutic innovations of the past decade, including widespread use of coronary reperfusion and revascularization, ␤-adrenoceptor blockade, and angiotensinconverting enzyme inhibition, have improved survival in the initial phases of MI associated with diminished ventricular function. [5][6][7][8] These efforts have contributed to a growing cohort of patients with chronic left ventricular dysfunction at risk for late death as a result of both arrhythmias and heart failure.…”

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confidence: 99%

Time Dependence of Mortality Risk and Defibrillator Benefit After Myocardial Infarction

et al. 2004

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Background-Prophylactic implantable defibrillators (ICDs) improve survival in patients with impaired ventricular function after myocardial infarction (MI), but it is uncertain whether mortality risk and survival benefit depend on the elapsed time from MI. Methods and Results-The Multicenter Automatic Defibrillator Implantation Trial II examined the impact of ICDs on survival in post-MI patients with ejection fractions Յ30%. In 1159 patients, mean time from most recent MI to enrollment was 81Ϯ78 months. Patients were randomized to an ICD (nϭ699) or conventional care (nϭ460) in a 3:2 ratio. Mortality rates (deaths per 100 person-years of follow-up) in both treatment groups were analyzed by time from MI divided into quartiles (Ͻ18, 18 to 59, 60 to 119, and Ն120 months). In conventional care patients, these rates increased as time from MI increased (7.8%, 8.4%, 11.6%, 14.0%; Pϭ0.03). Mortality rates in ICD patients were consistently lower in each quartile and showed minimal increase over time (7.2%, 4.9%, 8.2%, 9.0%; Pϭ0.19). Covariate-adjusted hazard ratios for risk of death associated with ICD therapy were 0.97 (95% CI, 0.51 to 1.81; Pϭ0.92) for recent MI (Ͻ18 months) and 0.55 (95% CI, 0.39 to 0.78; Pϭ0.001) for remote MI (Ն18 months). Conclusions-Mortality risk in patients with ejection fractions Յ30% increases as a function of time from MI. The survival benefit associated with ICDs appears to be greater for remote MI and remains substantial for up to Ն15 years after MI.

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Time Dependence of Mortality Risk and Defibrillator Benefit After Myocardial Infarction

et al. 2004

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“…10 This report describes a 1 year, randomized, doubleblinded, individually dose-adjusted, placebo-controlled trial to determine whether the administration of a membrane-active antiarrhythmic agent, aprindine, " influences survival in high-risk survivors of acute myocardial infarction. Aprindine, a tertiary amine with properties similar to those of quinidine and procainamide, 1 " was chosen as the test drug because it has several major advantages as a prophylactic agent against sudden death after myocardial infarction: (1) it is highly effective against serious ischemia-related arrhythmias; (2) it has a long half-life and predictable pharmacokinetics and may be taken on a twice-daily dosing schedule; (3) the most common side effects, including tremor, nervousness, dizziness and memory impairment, are dose related and readily reversible with dosage titration; and (4) major side effects, agran-THERAPY AND PREVENTION-SUDDEN DEATH ulocytosis and cholestatic jaundice, are relatively uncommon and reversible upon discontinuation of the drug.…”

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Prophylactic antiarrhythmic therapy of high-risk survivors of myocardial infarction: lower mortality at 1 month but not at 1 year.

Gottlieb¹,

Achuff²,

Mellits³

et al. 1987

Circulation

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To determine whether prophylactic antiarrhythmic therapy influences mortality in highrisk patients after acute myocardial infarction, 143 such patients were randomized in a double-blind individually dose-adjusted, placebo-controlled trial an average of 14 + 7 days after myocardial infarction and followed for 1 year. Patients were judged to be at high risk on the basis of (1) ejection fraction less than 40% (n = 60), (2) arrhythmias of Lown class 3 or higher (n = 26), or (3) both (n = 57). Aprindine was chosen because of its long half-life, few side effects, and antiarrhythmic efficacy. Baseline characteristics in the treatment arms did not differ. Holter-detected arrhythmias were reduced in aprindine-treated patients at 3 months (p < .001) and at 1 year (p < .001). One patient was lost to follow-up; in the remaining patients 1 year mortality was 20% (28/142; 12 aprindine and 16 placebo). There was no significant difference between the two study arms in overall mortality and sudden death. However, among those who died, median duration of survival was longer in aprindine-treated patients (86 vs 21.5 days) (p = .04). Although antiarrhythmic treatment with aprindine of high-risk patients after myocardial infarction does not affect 1 year survival, mortality appears to be delayed; thus there may be a role for short-term treatment before more definitive therapy such as surgery. Circulation 75, No. 4, 792-799, 1987. SUDDEN DEATH after hospital discharge following myocardial infarction is thought to be caused by malignant ventricular arrhythmias,l and patients with highgrade arrhythmias in the late hospital phase after myocardial infarction have an increased risk of sudden death after hospital discharge.2`7 Membrane-active antiarrhythmic agents reduce the frequency of ventricular arrhythmias in patients with acute and chronic coronary heart disease,8 and these agents have been studied in patients at risk of sudden death after myocardial infarction.9 10 To date, however, no study has shown convincingly that the prophylactic use of antiarrhythFrom the Francis

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“…These patients can now be evaluated by a growing list of invasive and noninvasive procedures, including echocardiography, predischarge exercise testing, ambulatory electrocardiographic monitoring, radionuclide coronary angiography, and electrophysiologic studies. 18 18 and the persistence, despite treatment with antiarrhythmic drugs, of lethal arrhythmias during electrophysiologic testing are markers that indicate patients at high risk of postinfarction sudden death. This sudden cardiac death is frequently the result of ventricular arrhythmias.…”

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confidence: 99%

Automatic external defibrillators: clinical issues for cardiology.

Cummins¹,

Eisenberg²,

Stults³

1986

Circulation

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Risk factors for sudden death after acute myocardial infarction: Two-year follow-up

Cited by 522 publications

References 35 publications

Time Dependence of Mortality Risk and Defibrillator Benefit After Myocardial Infarction

Time Dependence of Mortality Risk and Defibrillator Benefit After Myocardial Infarction

Prophylactic antiarrhythmic therapy of high-risk survivors of myocardial infarction: lower mortality at 1 month but not at 1 year.

Automatic external defibrillators: clinical issues for cardiology.

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