Document Detail


Pathogenesis of sudden unexpected death in a clinical trial of patients with myocardial infarction and left ventricular dysfunction, heart failure, or both.
MedLine Citation:
PMID:  20660803     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The frequency of sudden unexpected death is highest in the early post-myocardial infarction (MI) period; nevertheless, 2 recent trials showed no improvement in mortality with early placement of an implantable cardioverter-defibrillator after MI.
METHODS AND RESULTS: To better understand the pathophysiological events that lead to sudden death after MI, we assessed autopsy records in a series of cases classified as sudden death events in patients from the VALsartan In Acute myocardial infarctioN Trial (VALIANT). Autopsy records were available in 398 cases (14% of deaths). We determined that 105 patients had clinical circumstances consistent with sudden death. On the basis of the autopsy findings, we assessed the probable cause of sudden death and evaluated how these causes varied with time after MI. Of 105 deaths considered sudden on clinical grounds, autopsy suggested the following causes: 3 index MIs in the first 7 days (2.9%); 28 recurrent MIs (26.6%); 13 cardiac ruptures (12.4%); 4 pump failures (3.8%); 2 other cardiovascular causes (stroke or pulmonary embolism; 1.9%); and 1 noncardiovascular cause (1%). Fifty-four cases (51.4%) had no acute specific autopsy evidence other than the index MI and were thus presumed arrhythmic. The percentage of sudden death due to recurrent MI or rupture was highest in the first month after the index MI. By contrast, after 3 months, the percentage of presumed arrhythmic death was higher than recurrent MI or rupture (chi(2)=23.3, P<0.0001).
CONCLUSIONS: Recurrent MI or cardiac rupture accounts for a high proportion of sudden death in the early period after acute MI, whereas arrhythmic death may be more likely subsequently. These findings may help explain the lack of benefit of early implantable cardioverter-defibrillator therapy.
Authors:
Anne-Catherine Pouleur; Ebrahim Barkoudah; Hajime Uno; Hicham Skali; Peter V Finn; Steven L Zelenkofske; Yuri N Belenkov; Viacheslav Mareev; Eric J Velazquez; Jean L Rouleau; Aldo P Maggioni; Lars Køber; Robert M Califf; John J V McMurray; Marc A Pfeffer; Scott D Solomon;
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't     Date:  2010-07-26
Journal Detail:
Title:  Circulation     Volume:  122     ISSN:  1524-4539     ISO Abbreviation:  Circulation     Publication Date:  2010 Aug 
Date Detail:
Created Date:  2010-08-10     Completed Date:  2010-08-31     Revised Date:  2011-06-27    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  United States    
Other Details:
Languages:  eng     Pagination:  597-602     Citation Subset:  AIM; IM    
Affiliation:
Cardiovascular Division, Brigham and Women's Hospital, Boston, MA 02115, USA.
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Death, Sudden, Cardiac / epidemiology*,  etiology*
Female
Follow-Up Studies
Heart Failure / complications,  mortality*,  physiopathology
Humans
Male
Middle Aged
Myocardial Infarction / complications,  mortality*,  physiopathology
Time Factors
Ventricular Dysfunction, Left / complications,  mortality*,  physiopathology
Comments/Corrections
Comment In:
Circulation. 2011 May 10;123(18):e585; author reply e586-7   [PMID:  21555720 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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