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European Heart Journal Advance Access published online on October 23, 2009
European Heart Journal, doi:10.1093/eurheartj/ehp425
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2009. For permissions please email: journals.permissions@oxfordjournals.org

Predictors of sudden cardiac death change with time after myocardial infarction: results from the VALIANT trial

Jonathan P. Piccini1,*, Min Zhang1, Karen Pieper1, Scott D. Solomon2, Sana M. Al-Khatib1, Frans Van de Werf3, Marc A. Pfeffer2, John J.V. McMurray4, Robert M. Califf1 and Eric J. Velazquez1

1 Division of Cardiology, Duke Clinical Research Institute, Duke University Medical Center, DUMC #3115, Durham, NC 27705, USA
2 Brigham and Women's Hospital, Boston, MA, USA
3 University Hospital Gasthuisberg and Leuven Coordinating Center, Leuven, Belgium
4 Western Infirmary, Glasgow, Scotland

Received 16 January 2009; revised 22 May 2009; accepted 3 July 2009 * Corresponding author. Tel: +1 919 308 9861, Fax: +1 919 668 7058, Email: jonathan.piccini{at}duke.edu

Aims: To determine whether predictors of sudden cardiac death (SCD) vary with time after myocardial infarction (MI).

Methods and results: We analysed 11 256 patients enrolled in VALIANT. Landmark analysis and Cox proportional hazards modelling were used to predict SCD during hospitalization, from discharge to 30 days, 30 days to 6 months, and 6 months to 3 years. The cumulative incidence of SCD was 8.6% (n = 965). Initially, higher baseline heart rate [HR 1.20 per 10 b.p.m. (95% CI 1.06–1.37)] and impaired baseline creatinine clearance [HR 0.82 per 10 mL/min (95% CI 0.74–0.91)] were stronger predictors of SCD. With long-term follow-up, prior MI [HR 1.71 (95% CI 1.39–2.10)], initial left ventricular ejection fraction <40% [HR 0.67 per 10% (95% CI 0.58–0.78)], and recurrent cardiovascular events [HR 1.47 for rehospitalization (95% CI 1.17–1.86)] were more robust risk stratifiers for SCD. Atrial fibrillation post-MI was associated with an increased risk of SCD over the entire follow-up period. As time passed, the associations between baseline clinical characteristics and SCD decreased and time-updated assessments became more important.

Conclusion: Predictors of SCD change with time after MI. Future studies of risk stratification for SCD should account for changes in these factors with time after MI.

Key Words: Arrhythmia • Sudden death • Heart failure • Natural history


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