Sudden Death and Its Predictors in Myocardial Infarction Survivors in an Indian Population

Overview

Journal Indian Pacing Electrophysiol J

Date 2020 Dec 22

PMID 33352202

Citations 3

Authors

Raja J Selvaraj

Sasinthar Rangasamy

Dhivya Priya

Sreekumaran Nair

Ajith Ananthakrishna Pillai

Santhosh Satheesh

Balachander Jayaraman

Affiliations

Soon will be listed here.

Abstract

Objective: This study was conducted to assess the incidence of sudden cardiac death (SCD) in post myocardial infarction patients and to determine the predictive value of various risk markers in identifying cardiac mortality and SCD.

Methods: Left ventricular function, arrhythmias on Holter and microvolt T wave alternans (MTWA) were assessed in patients with prior myocardial infarction and ejection fraction ≤ 40%. The primary outcome was a composite of cardiac death and resuscitated cardiac arrest during follow up. Secondary outcomes included total mortality and SCD.

Results: Fifty-eight patients were included in the study. Eight patients (15.5%) died during a mean follow-up of 22.3 ± 6.6 months. Seven of them (12.1%) had SCD. Among the various risk markers studied, left ventricular ejection fraction (LVEF) ≤ 30% (Hazard ratio 5.6, 95% CI 1.39 to 23) and non-sustained ventricular tachycardia (NSVT) in holter (5.7, 95% CI 1.14 to 29) were significantly associated with the primary outcome in multivariate analysis. Other measures, including QRS width, heart rate variability, heart rate turbulence and MTWA showed no association.

Conclusions: Among patients with prior myocardial infarction and reduced left ventricular function, the rate of cardiac death was substantial, with most of these being sudden cardiac death. Both LVEF ≤30% and NSVT were associated with cardiac death whereas only LVEF predicted SCD. Other parameters did not appear useful for prediction of events in these patients. These findings have implications for decision making for the use of implantable cardioverter defibrillators for primary prevention in these patients.

Citing Articles

T-Wave Analysis on the 24 h Holter ECG Monitoring as a Predictive Assessment of Major Adverse Cardiovascular Events in Patients with Myocardial Infarction: A Literature Review and Future Perspectives.

Duca S, Roca M, Costache A, Chetran A, Afrasanie I, Miftode R Life (Basel). 2023; 13(5).

PMID: 37240799 PMC: 10222557. DOI: 10.3390/life13051155.

Contributions of the heart rate turbulence method to risk stratification in patients after myocardial infarction: a review.

Gomes R, Sa M, Sobral Filho D Am J Cardiovasc Dis. 2022; 12(1):19-30.

PMID: 35291511 PMC: 8918738.

Modified Moving Average T-wave alternans cutpoints.

Verrier R Indian Pacing Electrophysiol J. 2021; 21(2):139.

PMID: 33503470 PMC: 7952893. DOI: 10.1016/j.ipej.2021.01.009.

References

Rao B, Sastry B, Chugh S, Kalavakolanu S, Christopher J, Shangula D . Contribution of sudden cardiac death to total mortality in India - a population based study. Int J Cardiol. 2010; 154(2):163-7. DOI: 10.1016/j.ijcard.2010.09.016. View

Julian D, Camm A, Frangin G, Janse M, Munoz A, Schwartz P . Randomised trial of effect of amiodarone on mortality in patients with left-ventricular dysfunction after recent myocardial infarction: EMIAT. European Myocardial Infarct Amiodarone Trial Investigators. Lancet. 1997; 349(9053):667-74. DOI: 10.1016/s0140-6736(96)09145-3. View

Bauer A, Malik M, Schmidt G, Barthel P, Bonnemeier H, Cygankiewicz I . Heart rate turbulence: standards of measurement, physiological interpretation, and clinical use: International Society for Holter and Noninvasive Electrophysiology Consensus. J Am Coll Cardiol. 2008; 52(17):1353-65. DOI: 10.1016/j.jacc.2008.07.041. View

Nieminen T, Lehtimaki T, Viik J, Lehtinen R, Nikus K, Koobi T . T-wave alternans predicts mortality in a population undergoing a clinically indicated exercise test. Eur Heart J. 2007; 28(19):2332-7. DOI: 10.1093/eurheartj/ehm271. View

Schwartz P . The autonomic nervous system and sudden death. Eur Heart J. 1998; 19 Suppl F:F72-80. View

La Rovere M, Pinna G, Hohnloser S, MARCUS F, Mortara A, Nohara R . Baroreflex sensitivity and heart rate variability in the identification of patients at risk for life-threatening arrhythmias: implications for clinical trials. Circulation. 2001; 103(16):2072-7. DOI: 10.1161/01.cir.103.16.2072. View

Cairns J, Connolly S, Roberts R, Gent M . Randomised trial of outcome after myocardial infarction in patients with frequent or repetitive ventricular premature depolarisations: CAMIAT. Canadian Amiodarone Myocardial Infarction Arrhythmia Trial Investigators. Lancet. 1997; 349(9053):675-82. DOI: 10.1016/s0140-6736(96)08171-8. View

Kaufman E, Bloomfield D, Steinman R, Namerow P, Costantini O, Cohen R . "Indeterminate" microvolt T-wave alternans tests predict high risk of death or sustained ventricular arrhythmias in patients with left ventricular dysfunction. J Am Coll Cardiol. 2006; 48(7):1399-404. DOI: 10.1016/j.jacc.2006.06.044. View

Solomon S, Anavekar N, Skali H, McMurray J, Swedberg K, Yusuf S . Influence of ejection fraction on cardiovascular outcomes in a broad spectrum of heart failure patients. Circulation. 2005; 112(24):3738-44. DOI: 10.1161/CIRCULATIONAHA.105.561423. View

10.

Tanno K, Miyoshi F, Watanabe N, Minoura Y, Kawamura M, Ryu S . Are the MADIT II criteria for ICD implantation appropriate for Japanese patients?. Circ J. 2005; 69(1):19-22. DOI: 10.1253/circj.69.19. View

11.

Solomon S, Zelenkofske S, McMurray J, Finn P, Velazquez E, Ertl G . Sudden death in patients with myocardial infarction and left ventricular dysfunction, heart failure, or both. N Engl J Med. 2005; 352(25):2581-8. DOI: 10.1056/NEJMoa043938. View

12.

Exner D, Kavanagh K, Slawnych M, Mitchell L, Ramadan D, Aggarwal S . Noninvasive risk assessment early after a myocardial infarction the REFINE study. J Am Coll Cardiol. 2007; 50(24):2275-84. DOI: 10.1016/j.jacc.2007.08.042. View

13.

Chitnis N, Vooturi S, Rao B . Sudden cardiac death early after ST elevation myocardial infarction with and without severe left ventricular dysfunction. Indian Heart J. 2015; 66(6):569-73. PMC: 4311019. DOI: 10.1016/j.ihj.2014.10.416. View

14.

Hohnloser S, Ikeda T, Cohen R . Evidence regarding clinical use of microvolt T-wave alternans. Heart Rhythm. 2009; 6(3 Suppl):S36-44. DOI: 10.1016/j.hrthm.2008.10.011. View

15.

CARUSO A, MARCUS F, Hahn E, Hartz V, Mason J . Predictors of arrhythmic death and cardiac arrest in the ESVEM trial. Electrophysiologic Study Versus Electromagnetic Monitoring. Circulation. 1997; 96(6):1888-92. DOI: 10.1161/01.cir.96.6.1888. View

16.

Gold M, Bloomfield D, Anderson K, Wilber D, Groh W, Estes 3rd N . A comparison of T-wave alternans, signal averaged electrocardiography and programmed ventricular stimulation for arrhythmia risk stratification. J Am Coll Cardiol. 2000; 36(7):2247-53. DOI: 10.1016/s0735-1097(00)01017-2. View

17.

. Risk stratification and survival after myocardial infarction. N Engl J Med. 1983; 309(6):331-6. DOI: 10.1056/NEJM198308113090602. View

18.

Pfeffer M, McMurray J, Velazquez E, Rouleau J, Kober L, Maggioni A . Valsartan, captopril, or both in myocardial infarction complicated by heart failure, left ventricular dysfunction, or both. N Engl J Med. 2003; 349(20):1893-906. DOI: 10.1056/NEJMoa032292. View

19.

Siu C, Pong V, Ho H, Liu S, Lau C, Li S . Are MADIT II criteria for implantable cardioverter defibrillator implantation appropriate for Chinese patients?. J Cardiovasc Electrophysiol. 2009; 21(3):231-5. DOI: 10.1111/j.1540-8167.2009.01609.x. View

20.

Barthel P, Schneider R, Bauer A, Ulm K, Schmitt C, Schomig A . Risk stratification after acute myocardial infarction by heart rate turbulence. Circulation. 2003; 108(10):1221-6. DOI: 10.1161/01.CIR.0000088783.34082.89. View