Abstract 2637: Sudden Cardiac Death and Left Ventricular Ejection Fraction During Long-Term Follow-up After Acute Myocardial Infarction in the Primary Percutaneous Coronary Intervention Era. Results from the Heart Institute of Japan, Cardiology, Registry.
Background: Left ventricular ejection fraction (LVEF) is the most potent predictor of sudden cardiac death (SCD) in post myocardial infarction (MI) survivors. Currently, early revascularization such as primary percutaneous coronary intervention (PCI) reduces mortality in acute MI patients. The aim of this study was to determine the incidence of SCD according to LVEF in post MI survivors in the primary PCI era.
Methods: 4122 consecutive patients (mean age 66±12 years, 73.7% male) with acute MI who were discharged alive were enrolled immediately in a Japanese multicenter observational prospective registered cohort. All patients underwent determination of LVEF and assessment of cause of death. Patients were categorized into 3 groups according to LVEF>40%(n=3416), 30%<LVEF≤40%(n=507) and LVEF≤30%(n=199).
Results: 77.8% of patients received PCI and 3.7% received coronary bypass surgery. During an average follow-up of 4.1 years, mortality was 13.1% and SCD was 1.2%. Patients with LVEF≤30% and 30%<LVEF≤40% were both at comparable increased risk for mortality (HR 3.85, 95%CI:2.96 –5.00, P<0.001, HR 1.66, 95%CI:1.66 –2.57, P<0.001, respectively), and SCD (HR 5.99, 95%CI:2.73–13.14, P<0.001, HR 3.37, 95%CI:1.74 – 6.50, P<0.001, respectively), compared to patients with LVEF>40%.
Conclusions: There is a low incidence of SCD in post MI survivors in the primary PCI era, though LVEF influences its risk.