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Revascularization reduced sudden cardiac death risk after MI in patients with LV dysfunction
Post-MI patients with severe LV dysfunction who were treated with revascularization were less likely to experience sudden cardiac death in a recent study appearing in the journal Heart. Additionally, predictors of sudden cardiac death in these patients included age and left ventricular function ≤25%.
The aim of the prospective observational study was to determine the predictors of sudden cardiac death in the setting of revascularization of MI survivors with reduced LV ejection fraction. The researchers also aimed to determine incidence rates of sudden cardiac death in this cohort of 1,018 consecutive patients, of whom 53% received PCI and 14% CABG.
Eligible participants were accrued at FuWai Hospital in Beijing, China between 2004 and 2009. Eligibility criteria included an LV ejection fraction of ≤35% and NYHA class II/III HF at least 40 days after MI. Patients were enrolled if they were unavailable to receive an implantable cardioverter defibrillator.
Clinicians analyzed patients for the degree of CAD and revascularization.
Sudden cardiac death served as the primary outcome measure. All-cause mortality served as the secondary outcome measure.
The median follow-up duration was 2.8 years.
A 5% sudden cardiac death rate was reported, along with an all-cause death rate of 7.4%.
Sudden cardiac death occurred at an annual incidence rate of 1.8%.
Patients with triple-vessel disease carried a 6.7% cumulative incidence rate of sudden cardiac death compared with 0.6% for those with single-vessel disease (log-rank P<.05). Patients with left main coronary disease experienced a 10.3% rate of sudden cardiac death compared with 4.1% among patients with no left main coronary disease (P<.05).
Similarly, presence of ejection fraction ≤25% yielded an 8.3% sudden cardiac death rate vs. 3.9% among those without this ejection fraction rate (P<.05). The presence of non-revascularization therapy was also associated with increased sudden cardiac death compared with the absence of this therapy (9.6% vs. 2.7%; P<.05).
Multivariate analysis results indicated several predictors of sudden cardiac death, including age
(HR=1.05; 95% CI, 1.02-1.09), ejection fraction ≤25% (HR=1.82; 95% CI, 1.04-3.21) and non-revascularization (HR=3.97; 95% CI, 2.15-7.31).
Disclosure: The researchers report no relevant financial disclosures.