Do sudden cardiac death rates warrant earlier treatment following myocardial infarction? experience from the VALIANT Trial

Zelenkofske, S., McMurray, J.J.V. , Califf, R.M., Rouleau, J.L., Pfeffer, M.A., Ertl, G., Harsanyi, A. and Solomon, S.D. (2004) Do sudden cardiac death rates warrant earlier treatment following myocardial infarction? experience from the VALIANT Trial. Journal of Cardiac Failure, 10(4), S71. (doi: 10.1016/j.cardfail.2004.06.196)

Abstract

Purpose: Patients with left ventricular ejection fraction (LVEF) ≤30% following myocardial infarction (MI) are at greater risk for sudden cardiac death (SCD). Current guidelines recommend implantable cardioverter defibrillator (ICD) placement in patients with EF ≤30% beyond 30 days post-MI. We determined the incidence and timing of SCD in a high-risk MI population. Methods: The VALsartan In Acute myocardial iNfarcTion (VALIANT) trial enrolled 14,703 patients with left ventricular systolic dysfunction (LVSD), heart failure (HF), or both following MI (median 4.9 days post-MI, mean age 64.8 years, 31% women, mean EF 35.3%). SCD was defined as unexpected out-of-hospital death by a central committee. Results: EF was recorded in 11,338 patients. A total of 925 patients experienced SCD during the study. Of these, 634 occurred in the first year and 131 occurred within 30 days. Among patients with EF ≤30% (n = 2468), 335 had SCD in year 1 with 74 occurring ≤30 days. Of 5830 patients with EF 30–40%, 213 had SCD in year 1 with 38 occurring ≤30 days. Of 3040 patients with EF >40%, only 84 had SCD in the first year (Figure). Conclusions: More than half of the patients who had SCD post-MI had an EF <30%. In patients meeting current LVEF criteria for ICD, 22% had sudden death within 30 days of MI, suggesting a role for earlier implantation of ICD after MI.[figure1]

• Item Type: Articles
• Additional Information: Abstracts from the 8th Annual Scientific Meeting of the Heart Failure Society of America.
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: McMurray, Professor John
• Authors: Zelenkofske, S., McMurray, J.J.V., Califf, R.M., Rouleau, J.L., Pfeffer, M.A., Ertl, G., Harsanyi, A., and Solomon, S.D.
• College/School: College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
• Journal Name: Journal of Cardiac Failure
• Publisher: Elsevier
• ISSN: 1071-9164
• ISSN (Online): 1532-8414