Principal factors affecting sudden death risk in myocardial infarction patients

Abstract

Aim. To assess prognostic value of clinical and functional factors in regard to sudden cardiac death (SCD) risk in patients after myocardial infarction (MI). Material and methods. In total, 420 patients were examined at Day 10-14 after MI; follow-up period lasted for 14 years. General clinical examination, echocardiography, 24-hour electrocardiography (ECG) monitoring, late ventricular potentials (LVP) detection, active orthostatic test (AOT), heart rate variability (HRV) assessment at baseline and during functional tests, as well as psychological testing, were performed. SCD risk was assessed by Cox multi-factor analysis and Kaplan-Meier survival curve method. Results. According to Cox multivariate regression analysis, the most important predictors included the following: LVP, HRV reduction, left ventricular ejection fraction <40%, ventricular arrhythmias, previous MI, and hypotension in AOT. Prognostic accuracy and positive predictive value of this model were high enough to assess SCD risk. Conclusion. To assess SCD risk in MI patients, complex clinical and functional factors - SCD predictors – should be measured.

Keywords

• sudden death
• myocardial infarction
• prognosis
• risk stratification