Incidence of and risk stratification for sudden cardiac death after acute myocardial infarction
- Philip J Podrid, MD, FACC
Philip J Podrid, MD, FACC
- Professor of Medicine, Professor of Pharmacology and Experimental Therapeutics
- Boston University School of Medicine
- Lecturer, Harvard Medical School
- Leonard I Ganz, MD, FHRS, FACC
Leonard I Ganz, MD, FHRS, FACC
- Section Editor — Cardiac Arrhythmias
- Director of Cardiac Electrophysiology
- Heritage Valley Health System
- Section Editors
- Peter J Zimetbaum, MD
Peter J Zimetbaum, MD
- Section Editor — Cardiac Arrhythmias
- Professor of Medicine
- Harvard Medical School
- Bernard J Gersh, MB, ChB, DPhil, FRCP, MACC
Bernard J Gersh, MB, ChB, DPhil, FRCP, MACC
- Editor-in-Chief — Cardiovascular Medicine
- Section Editor — Coronary Heart Disease; Myopericardial Disease
- Professor of Medicine
- Mayo Clinic College of Medicine
The process of risk stratification in a patient who has had an acute myocardial infarction (MI) has two components:
●Early in-hospital identification of patients at increased risk for recurrent ischemic events
●Identification of patients at increased risk for arrhythmic or nonarrhythmic death
Patients who have had an acute MI are at increased risk for sudden cardiac death (SCD), most often due to a ventricular tachyarrhythmia. However, not all post-MI patients have the same risk of SCD. Thus, the therapeutic approach to the prevention of SCD depends upon the identification of those patients who are most likely to have a ventricular tachyarrhythmia and the effectiveness of the available preventive measures [1,2].
The incidence of SCD after acute MI and identification of patients at increased risk for SCD will be reviewed here. Issues related to the primary prevention of arrhythmic death, to the treatment of patients who have already experienced a serious sustained ventricular arrhythmia (secondary prevention), and to risk stratification for recurrent ischemic events after ST elevation and non-ST elevation infarctions are discussed separately. (See "Clinical features and treatment of ventricular arrhythmias during acute myocardial infarction" and "Sustained monomorphic ventricular tachycardia in patients with a prior myocardial infarction: Treatment and prognosis" and "Risk stratification after acute ST-elevation myocardial infarction" and "Risk stratification after non-ST elevation acute coronary syndrome" and "Primary prevention of sudden cardiac death in heart failure and cardiomyopathy".)
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- INCIDENCE OF SCD
- Time after MI
- - Elevated early risk
- - Limitations of early risk stratification
- RISK FACTORS
- Impact of age, ethnicity, and comorbidities
- LV dysfunction
- Inducible VT/VF
- - Role in severe LV dysfunction
- VPBs on monitoring
- NSVT on monitoring
- Sustained monomorphic VT
- QRS prolongation
- Late potentials on SAECG
- Reduced HRV
- T wave (repolarization) alternans
- Cardiac magnetic resonance imaging
- RISK STRATIFICATION STRATEGIES
- Recommendations of major societies
- Use of multiple variables
- Low-risk subgroups
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS
- Standard approach
- Additional studies
- Identification of low-risk patients