Sudden death after myocardial infarction

A Selcuk Adabag, Terry M Therneau, Bernard J Gersh, Susan A Weston, Véronique L Roger, A Selcuk Adabag, Terry M Therneau, Bernard J Gersh, Susan A Weston, Véronique L Roger

Abstract

Context: Sudden cardiac death after myocardial infarction (MI) has not been assessed recently in the community. Risk stratification for sudden cardiac death after MI commonly relies on baseline characteristics and little is known about the relationship between recurrent ischemia or heart failure and sudden cardiac death.

Objective: To evaluate the risk of sudden cardiac death after MI and the impact of recurrent ischemia and heart failure on sudden cardiac death.

Design, setting, and participants: Population-based surveillance study of 2997 residents (mean [SD] age, 67 [14] years; 59% were men) experiencing an MI in Olmsted County, Minnesota, between 1979 and 2005, and followed up through February 29, 2008.

Main outcome measures: Sudden cardiac death defined as out-of-hospital death due to coronary disease; and observed survival free of sudden cardiac death compared with that expected in Olmsted County, Minnesota.

Results: During a median follow-up of 4.7 years (25th-75th percentile, 1.6-7.1 years), 1160 deaths occurred, 282 from sudden cardiac death (24%). The 30-day cumulative incidence of sudden cardiac death was 1.2% (95% confidence interval [CI], 0.8%-1.6%). Thereafter, the rate of sudden cardiac death was constant at 1.2% per year yielding a 5-year cumulative incidence of 6.9% (95% CI, 5.9%-7.9%). The 30-day incidence of sudden cardiac death was 4-fold higher than expected (standardized mortality ratio, 4.2; 95% CI, 2.9-5.8). The risk of sudden cardiac death has declined significantly over time (hazard ratio [HR], 0.62 [95% CI, 0.44-0.88] for MIs that occurred between 1997 and 2005 compared with between 1979 and 1987; P = .03). The recurrent events of ischemia (n = 842), heart failure (n = 365), or both (n = 873) occurred in 2080 patients. After adjustment for baseline characteristics, recurrent ischemia was not associated with sudden cardiac death (HR, 1.26 [95% CI, 0.96-1.65]; P = .09), while heart failure markedly increased the risk of sudden cardiac death (HR, 4.20 [95% CI, 3.10-5.69]; P < .001).

Conclusions: The risk of sudden cardiac death following MI in community practice has declined significantly over the past 30 years. Sudden cardiac death is independently associated with heart failure but not with recurrent ischemia.

Figures

Figure 1
Figure 1
Cumulative incidence of sudden death and all-cause mortality after myocardial infarction among residents of Olmsted County, Minnesota.
Figure 2
Figure 2
Cumulative incidence of recurrent ischemic events and heart failure after myocardial infarction among residents of Olmsted County, Minnesota.

References

    1. Huikuri HV, Castellanos A, Myerburg RJ. Sudden death due to cardiac arrhythmias. N Engl J Med. 2001 Nov 15;345(20):1473–1482.
    1. Risk stratification and survival after myocardial infarction. N Engl J Med. 1983 Aug 11;309(6):331–336.
    1. Berger CJ, Murabito JM, Evans JC, Anderson KM, Levy D. Prognosis after first myocardial infarction. Comparison of Q-wave and non-Q-wave myocardial infarction in the Framingham Heart Study. Jama. 1992 Sep 23–30;268(12):1545–1551.
    1. Kannel WB, Sorlie P, McNamara PM. Prognosis after initial myocardial infarction: the Framingham study. Am J Cardiol. 1979 Jul;44(1):53–59.
    1. Marcus FI, Cobb LA, Edwards JE, et al. Mechanism of death and prevalence of myocardial ischemic symptoms in the terminal event after acute myocardial infarction. Am J Cardiol. 1988 Jan 1;61(1):8–15.
    1. Mukharji J, Rude RE, Poole WK, et al. Risk factors for sudden death after acute myocardial infarction: two-year follow-up. Am J Cardiol. 1984 Jul 1;54(1):31–36.
    1. Fox CS, Evans JC, Larson MG, Kannel WB, Levy D. Temporal trends in coronary heart disease mortality and sudden cardiac death from 1950 to 1999: the Framingham Heart Study. Circulation. 2004 Aug 3;110(5):522–527.
    1. Gerber Y, Jacobsen SJ, Frye RL, Weston SA, Killian JM, Roger VL. Secular trends in deaths from cardiovascular diseases: a 25-year community study. Circulation. 2006 May 16;113(19):2285–2292.
    1. Goldberg RJ, Gorak EJ, Yarzebski J, et al. A communitywide perspective of sex differences and temporal trends in the incidence and survival rates after acute myocardial infarction and out-of-hospital deaths caused by coronary heart disease. Circulation. 1993 Jun;87(6):1947–1953.
    1. McGovern PG, Pankow JS, Shahar E, et al. Recent trends in acute coronary heart disease--mortality, morbidity, medical care, and risk factors. The Minnesota Heart Survey Investigators. N Engl J Med. 1996 Apr 4;334(14):884–890.
    1. Roger VL, Jacobsen SJ, Weston SA, et al. Trends in the incidence and survival of patients with hospitalized myocardial infarction, Olmsted County, Minnesota, 1979 to 1994. Ann Intern Med. 2002 Mar 5;136(5):341–348.
    1. Abildstrom SZ, Rask-Madsen C, Ottesen MM, et al. Impact of age and sex on sudden cardiovascular death following myocardial infarction. Heart. 2002 Dec;88(6):573–578.
    1. Solomon SD, Zelenkofske S, McMurray JJ, et al. Sudden death in patients with myocardial infarction and left ventricular dysfunction, heart failure, or both. N Engl J Med. 2005 Jun 23;352(25):2581–2588.
    1. Yap YG, Duong T, Bland M, et al. Temporal trends on the risk of arrhythmic vs. non-arrhythmic deaths in high-risk patients after myocardial infarction: a combined analysis from multicentre trials. Eur Heart J. 2005 Jul;26(14):1385–1393.
    1. Huikuri HV, Tapanainen JM, Lindgren K, et al. Prediction of sudden cardiac death after myocardial infarction in the beta-blocking era. J Am Coll Cardiol. 2003 Aug 20;42(4):652–658.
    1. Jordaens L, Tavernier R. Determinants of sudden death after discharge from hospital for myocardial infarction in the thrombolytic era. Eur Heart J. 2001 Jul;22(14):1214–1225.
    1. Makikallio TH, Barthel P, Schneider R, et al. Frequency of sudden cardiac death among acute myocardial infarction survivors with optimized medical and revascularization therapy. Am J Cardiol. 2006 Feb 15;97(4):480–484.
    1. Rouleau JL, Talajic M, Sussex B, et al. Myocardial infarction patients in the 1990s--their risk factors, stratification and survival in Canada: the Canadian Assessment of Myocardial Infarction (CAMI) Study. J Am Coll Cardiol. 1996 Apr;27(5):1119–1127.
    1. Steg PG, Lopez-Sendon J, Lopez de Sa E, et al. External validity of clinical trials in acute myocardial infarction. Arch Intern Med. 2007 Jan 8;167(1):68–73.
    1. Hohnloser SH, Gersh BJ. Changing late prognosis of acute myocardial infarction: impact on management of ventricular arrhythmias in the era of reperfusion and the implantable cardioverter-defibrillator. Circulation. 2003 Feb 25;107(7):941–946.
    1. Moss AJ, Zareba W, Hall WJ, et al. Prophylactic implantation of a defibrillator in patients with myocardial infarction and reduced ejection fraction. N Engl J Med. 2002 Mar 21;346(12):877–883.
    1. Hohnloser SH, Kuck KH, Dorian P, et al. Prophylactic use of an implantable cardioverter-defibrillator after acute myocardial infarction. N Engl J Med. 2004 Dec 9;351(24):2481–2488.
    1. Wilber DJ, Zareba W, Hall WJ, et al. Time dependence of mortality risk and defibrillator benefit after myocardial infarction. Circulation. 2004 Mar 9;109(9):1082–1084.
    1. Myerburg RJ, Kessler KM, Castellanos A. Sudden cardiac death. Structure, function, and time-dependence of risk. Circulation. 1992 Jan;85(1 Suppl):I2–I10.
    1. Salukhe TV, Dimopoulos K, Sutton R, Coats AJ, Piepoli M, Francis DP. Life-years gained from defibrillator implantation: markedly nonlinear increase during 3 years of follow-up and its implications. Circulation. 2004 Apr 20;109(15):1848–1853.
    1. Roger VL, Killian J, Henkel M, et al. Coronary disease surveillance in Olmsted County objectives and methodology. J Clin Epidemiol. 2002 Jun;55(6):593–601.
    1. White AD, Folsom AR, Chambless LE, et al. Community surveillance of coronary heart disease in the Atherosclerosis Risk in Communities (ARIC) Study: methods and initial two years' experience. J Clin Epidemiol. 1996 Feb;49(2):223–233.
    1. Prineas R, Crow R, Blackbur H. The Minnesota Code Manual of Electrocardiographic Findings: Standards and Procedures for Measurements and Classification. Liettleton, MA: Wright-PSG; 1982.
    1. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373–383.
    1. Ho KK, Pinsky JL, Kannel WB, Levy D. The epidemiology of heart failure: the Framingham Study. J Am Coll Cardiol. 1993 Oct;22(4 Suppl A):6A–13A.
    1. Goraya TY, Jacobsen SJ, Kottke TE, Frye RL, Weston SA, Roger VL. Coronary heart disease death and sudden cardiac death: a 20-year population-based study. Am J Epidemiol. 2003 May 1;157(9):763–770.
    1. Jokhadar M, Jacobsen SJ, Reeder GS, Weston SA, Roger VL. Sudden death and recurrent ischemic events after myocardial infarction in the community. Am J Epidemiol. 2004 Jun 1;159(11):1040–1046.
    1. Goraya TY, Jacobsen SJ, Belau PG, Weston SA, Kottke TE, Roger VL. Validation of death certificate diagnosis of out-of-hospital coronary heart disease deaths in Olmsted County, Minnesota. Mayo Clin Proc. 2000 Jul;75(7):681–687.
    1. Gooley TA, Leisenring W, Crowley J, Storer BE. Estimation of failure probabilities in the presence of competing risks: new representations of old estimators. Stat Med. 1999 Mar 30;18(6):695–706.
    1. Bardy GH, Lee KL, Mark DB, et al. Home use of automated external defibrillators for sudden cardiac arrest. N Engl J Med. 2008 Apr 24;358(17):1793–1804.
    1. Bunch TJ, Hohnloser SH, Gersh BJ. Mechanisms of sudden cardiac death in myocardial infarction survivors: insights from the randomized trials of implantable cardioverter-defibrillators. Circulation. 2007 May 8;115(18):2451–2457.
    1. Guidry UC, Evans JC, Larson MG, Wilson PW, Murabito JM, Levy D. Temporal trends in event rates after Q-wave myocardial infarction: the Framingham Heart Study. Circulation. 1999 Nov 16;100(20):2054–2059.
    1. Hellermann JP, Goraya TY, Jacobsen SJ, et al. Incidence of heart failure after myocardial infarction: is it changing over time? Am J Epidemiol. 2003 Jun 15;157(12):1101–1107.
    1. Bursi F, Weston SA, Killian JM, Gabriel SE, Jacobsen SJ, Roger VL. C-reactive protein and heart failure after myocardial infarction in the community. Am J Med. 2007 Jul;120(7):616–622.
    1. Spencer FA, Meyer TE, Goldberg RJ, et al. Twenty year trends (1975–1995) in the incidence, in-hospital and long-term death rates associated with heart failure complicating acute myocardial infarction: a community-wide perspective. J Am Coll Cardiol. 1999;34(5):1378–1387.
    1. Singh JP, Hall WJ, McNitt S, et al. Factors influencing appropriate firing of the implanted defibrillator for ventricular tachycardia/fibrillation: findings from the Multicenter Automatic Defibrillator Implantation Trial II (MADIT-II) J Am Coll Cardiol. 2005 Nov 1;46(9):1712–1720.
    1. Myerburg RJ, Mitrani R, Interian A, Jr, Castellanos A. Interpretation of outcomes of antiarrhythmic clinical trials: design features and population impact. Circulation. 1998 Apr 21;97(15):1514–1521.
    1. Devlin G, Anderson FA, Heald S, et al. Management and outcomes of lower risk patients presenting with acute coronary syndromes in a multinational observational registry. Heart. 2005 Nov;91(11):1394–1399.
    1. Fox KA, Anderson FA, Jr, Dabbous OH, et al. Intervention in acute coronary syndromes: do patients undergo intervention on the basis of their risk characteristics? The Global Registry of Acute Coronary Events (GRACE) Heart. 2007 Feb;93(2):177–182.
    1. Vaccarino V, Rathore SS, Wenger NK, et al. Sex and racial differences in the management of acute myocardial infarction, 1994 through 2002. N Engl J Med. 2005 Aug 18;353(7):671–682.
    1. Wiviott SD, Morrow DA, Frederick PD, Antman EM, Braunwald E. Application of the Thrombolysis in Myocardial Infarction risk index in non-ST-segment elevation myocardial infarction: evaluation of patients in the National Registry of Myocardial Infarction. J Am Coll Cardiol. 2006 Apr 18;47(8):1553–1558.
    1. Rogers WJ, Canto JG, Lambrew CT, et al. Temporal trends in the treatment of over 1.5 million patients with myocardial infarction in the US from 1990 through 1999: the National Registry of Myocardial Infarction 1, 2 and 3. J Am Coll Cardiol. 2000 Dec;36(7):2056–2063.
    1. Steg PG, Goldberg RJ, Gore JM, et al. Baseline characteristics, management practices, and in-hospital outcomes of patients hospitalized with acute coronary syndromes in the Global Registry of Acute Coronary Events (GRACE) Am J Cardiol. 2002 Aug 15;90(4):358–363.
    1. Watkins S, Thiemann D, Coresh J, Powe N, Folsom AR, Rosamond W. Fourteen-year (1987 to 2000) trends in the attack rates of, therapy for, and mortality from non-ST-elevation acute coronary syndromes in four United States communities. Am J Cardiol. 2005 Nov 15;96(10):1349–1355.
    1. Gandy A, Therneau TM, Aalen OO. Global tests in the additive hazards regression model. Stat Med. 2008 Mar 15;27(6):831–844.
    1. Lloyd-Jones DM, Tian L. Predicting cardiovascular risk: so what do we do now? Arch Intern Med. 2006 Jul 10;166(13):1342–1344.
    1. Pencina MJ, D'Agostino RB, Sr, D'Agostino RB, Jr, Vasan RS. Evaluating the added predictive ability of a new marker: from area under the ROC curve to reclassification and beyond. Stat Med. 2008 Jan 30;27(2):157–172. discussion 207–112.

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