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Risk for sudden cardiac death increased in month following MI

Issue: December 2008

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The risk for sudden cardiac death following MI has decreased during the past 30 years, study results suggested.

Researchers conducted a population-based surveillance study of 2,997 residents of Olmstead County, Minn. who experienced an MI between 1979 and 2005 and followed them through 2008. The primary endpoint was sudden cardiac death defined as out-of-hospital death due to coronary disease.

According to the researchers, 1,160 deaths occurred during the median follow-up period of 4.7 years. Deaths (n=282) were classified as sudden cardiac deaths. The researchers also reported 35 sudden cardiac deaths within 30 days of leaving the hospital (cumulative incidence, 1.2%; 95% CI, 0.8%-1.6%). The risk for sudden cardiac death following MI also decreased during the study period. Using sudden cardiac death after MI occurring between 1979 and 1987 as a baseline, the researchers reported that the risk for sudden cardiac death following MI between 1988 and 1996 declined by 20% (HR=0.80; 95% CI, 0.60-1.07) and was 38% lower for MIs occurring between 1997 and 2005 (HR=0.62; 95% CI, 0.44-0.88).

“In the community, the risk for sudden cardiac death is the highest during the first month after MI when it markedly exceeds the rate in the general population,” the researchers wrote. “Among 30-day survivors, the risk for sudden cardiac death declines rapidly but is markedly increased by the occurrence of HF during follow-up.” – by Eric Raible

For more information:

• JAMA. 2008;300:2022-2029.

This really has had very little effect on my practice because most sudden deaths occur outside the hospital and most are not witnessed, so patients die without being resuscitated. We noted the same thing some years ago in the Worcester Heart Attack Study and felt it was the result of earlier detection and therapy of CAD, hyperlipidemia, diabetes and hypertension. Decreased smoking in middle-aged men is probably also contributing to the decline.

– Joseph Alpert, MD
Cardiology Today Editorial Board member