Sudden cardiac death in long-term follow-up in patients treated with primary percutaneous coronary intervention

Abstract

Objective. Most studies analyzing predictors of sudden cardiac death (SCD) after acute myocardial infarction included only high-risk patients or index reperfusion had not been performed in all patients. The aim of our study was to analyze the incidence of SCD and determine the predictors of SCD occurrence during 6-year follow-up of unselected patients with ST-elevation myocardial infarction (STEMI), treated with primary percutaneous coronary intervention (pPCI). Method. we analysed 3114 STEMI patients included included in the University Clinical Center of Serbia STEMI Register. Patients presenting with cardiogenic schock were excluded. Echocardiographic examination was performed before hospital discharge. Results. During 6-year follow-up, lethal outcome was registered in 297 (9.5%) patients, of whom 95 (31.9%) had SCD. The highest incidence of SCD was recorded in the first year of follow-up, when SCD was registered in 25 patients, which is 26.3% of the total number of patients who had had SCD, i.e. 0.8% of the patients analyzed. The independent predictors for the occurrence of SCD during 6-year follow-up were EF < 45% (HR 3.07, 95% 1.87–5.02), post-procedural TIMI flow <3 (HR 2.59, 95%CI 1.37–5.14), reduced baseline kidney function (HR 1.87, 95%CI 1.12–2.93) and Killip class >1 at admission (HR 1.69, 95%CI 1.23–2.97). Conclusion. There is a low incidence of SCD in unselected STEMI patients treated with primary PCI. Predictors of SCD occurence during long-term follow-up in analyzed patients are clinical variables that are easily recorded during index hospitalization and include: EF ≤45%, post-procedural flow TIMI < 3, Killip class >1, and reduced baseline kidney function.

Keywords:

• Sudden cardiac death
• myocardial infarction
• primary percutaneous coronary intervention
• predictors

Acknowledgements

The authors express their gratitude to the physicians and nurses of the Coronary Unit and the Catheterization Laboratory participating in the primary PCI program

Author contributions

LS and IM conceived of the study and participated in its design, acquisition of data and coordination. LS performed statistical analysis. MA, SS, GK, RL and DS participated in the design of the study and helped to draft the manuscript. All authors read and approved the final manuscript.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.