Characterization of sudden death following myocardial infarction

January 01, 0001

Characterization of sudden death following myocardial infarction

A feared sequelae of myocardial infarction is sudden death (SD). These US, UK, and Danish researchers examined data from patients who suffered SD in the Valsartan in Acute Myocardial Infarction Trial (VALIANT) trial (n=1067). They characterized the circumstances of the SD events and also measured long-term mortality in those patients who were successfully resuscitated.

The researchers found: "Although SD was more likely to occur at home (645 of 978, 66%) than in hospital (204 of 978, 21%), the proportion of in- hospital events was higher early on (99 of 226, 44%). Home events were less likely to be witnessed regardless of time frame. Preceding activity was known for 42% of patients with home arrest. Of these, 52% were determined to be asleep at time of event, and these deaths were more likely to be unwitnessed. A majority of patients for whom initial ECG rhythm was reported had ventricular tachycardia/ventricular fibrillation (189 of 283, 67%). Of the 155 patients successfully resuscitated, 24% subsequently received an implantable cardioverter-defibrillator. Nineteen percent of those who received an implantable cardioverter-defibrillator subsequently died compared with 49% of patients who did not receive an implantable cardioverter-defibrillator (hazard ratio, 0.36)."

The researchers concluded: "A high proportion of SD events after high-risk myocardial infarction occurred at home, but in-hospital events were more common early on. Patients who were asleep were more likely to have unwitnessed arrests. Alternative strategies for the prevention of SD in patients who are not candidates for implantable cardioverter-defibrillator will need to take into account the circumstances of SD events."

This study sheds some light on sudden death following myocardial infarction and reinforces the benefit of implanted defibrillators.

For the full abstract, click here.

Circulation 123(23): 2674-2680, 14 June 2011 © 2011 American Heart Association, Inc.
Circumstances and Outcomes of Sudden Unexpected Death in Patients With High-Risk Myocardial Infarction: Implications for Prevention. Siqin Ye, Matthew Grunnert, Jens Jakob Thune, et al. Correspondence to Siqin Ye: [email protected]

Category: K. Circulatory. Keywords: sudden death, myocardial infarction, defibrillator, AICD, valsartan, observational study, journal watch.
Synopsis edited by Dr Paul Schaefer, Toledo, Ohio. Posted on Global Family Doctor 19 July 2011

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.

COVID-19 Resources

WONCA webinars, journal links and more

WONCA position statements

WONCA statements on a variety of issues

PEARLS

577 Individual behavioural counselling helps people to quit smoking 575 Antioxidant vitamin and mineral supplements may be beneficial in age-related macular degeneration 574 Oral antifungals effective for toenail onychomycosis 570 Decision aids beneficial for people facing health treatment or screening decisions 569 Computer-generated reminders on paper benefit quality of care