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Out-of-Hospital Cardiac Arrest After Myocardial Infarction
Quick Takes
- In a contemporary nationwide Swedish registry, the incidence of out-of-hospital cardiac arrest (OHCA) within 90 days after MI is 0.3% in patients who had undergone in-hospital coronary angiography and were discharged without an ICD.
- In addition to LVEF, predictors of OHCA included male sex, diabetes, renal impairment, heart failure, and newly identified atrial fibrillation or atrial flutter.
Study Questions:
What is the incidence of sudden cardiac death (SCD) and its predictors early after myocardial infarction (MI) in contemporary Sweden?
Methods:
The authors used data from SWEDEHEART, the Swedish Cardiopulmonary Resuscitation Registry, and the Swedish Pacemaker and Implantable Cardioverter-Defibrillator (ICD) Registry. Cases of MI, which had undergone coronary angiography and were discharged alive between 2009-2017 without a prior ICD, were followed up to 90 days. Cox regression models were used to assess associations between clinical parameters and out-of-hospital cardiac arrest (OHCA).
Results:
Among 121,379 cases, OHCA occurred in 349 (0.29%) and non-OHCA death in 2,194 (1.8%). A total of six variables (male sex, diabetes, estimated glomerular filtration rate <30 ml/min/1.73 m2, Killip class ≥II, new-onset atrial fibrillation/flutter, and impaired left ventricular ejection fraction [LVEF] categorized as 40-49%, 30-39%, and <30%) were identified as independent predictors, were assigned points, and were grouped into three categories, where the incidence of OHCA ranged from 0.12-2.0% and non-OHCA death from 0.76-11.7%.
Conclusions:
In this nationwide study, the incidence of OHCA within 90 days after MI was <0.3%. A total of five clinical parameters in addition to LVEF predicted OHCA and non-OHCA death better than LVEF alone.
Perspective:
The current analysis shows that the incidence of SCD within 90 days following MI and angiography is about 0.3%, which is lower than prior studies and historical data revealed. This may in part be due to improved rates of revascularization and guideline-directed medical treatment. In addition to LVEF, predictors of OHCA included male sex, diabetes, renal impairment, heart failure, and newly identified atrial fibrillation or atrial flutter. Further studies are needed to assess the utility of incorporating selection criteria beyond LVEF to identify patients who benefit from strategies to prevent OHCA early after MI.
Clinical Topics: Acute Coronary Syndromes, Arrhythmias and Clinical EP, Cardiovascular Care Team, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Prevention, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Acute Heart Failure, Interventions and ACS, Interventions and Imaging, Angiography, Nuclear Imaging
Keywords: Acute Coronary Syndrome, Arrhythmias, Cardiac, Atrial Fibrillation, Atrial Flutter, Coronary Angiography, Death, Sudden, Cardiac, Defibrillators, Implantable, Diabetes Mellitus, Glomerular Filtration Rate, Heart Failure, Myocardial Infarction, Out-of-Hospital Cardiac Arrest, Patient Discharge, Renal Insufficiency, Secondary Prevention, Stroke Volume, Ventricular Function, Left
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