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European Heart Journal 2001 22(14):1214-1225; doi:10.1053/euhj.2000.2464
Copyright © 2001 by the European Society of Cardiology.
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Determinants of sudden death after discharge from hospital for myocardial infarction in the thrombolytic era

L Jordaensf1 and R Tavernier MIRRACLE Investigators

University Hospital of Ghent, Ghent, Belgium

revised August 31, 2000; accepted September 18, 2000

Abstract

Aims The purpose of this study was to assess risk factors for sudden death after discharge from hospital for myocardial infarction in an era in which 50% of patients receive thrombolytic drugs.

Methods and Results We prospectively studied 708 consecutive survivors of myocardial infarction admitted to hospitals, which had registered their clinical, functional, and electrical parameters. A total of 83 patients died in the first 2 years (12%) after discharge. Sudden death was only observed in 12 patients. In multivariate analysis only NYHA class >I, and a filtered QRS duration ≥110ms were important predictive variables for sudden death. A pre-defined high-risk group of 25 patients had no sudden death. When the strongest predictive variables in univariate analysis were combined to increase the positive predictive value for sudden death, we only achieved a maximal value of 27%.

Conclusions In an unselected infarction population, the risk for sudden death is low in the first 2 years. Therefore, prediction and prophylactic intervention, such as defibrillator therapy become difficult. The event is related to cardiac dysfunction on admission, and with abnormalities in the filtered electrocardiogram.

Key Words: Coronary artery disease, late potentials, mortality, myocardial infarction, repolarization, sudden death

f1 Correspondence: Dr L. Jordaens, Heart Centre Rotterdam, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands.

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