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Bui AH, Waks JW. Risk Stratification of Sudden Cardiac Death After Acute Myocardial Infarction. J Innov Card Rhythm Manag. 2018;9(2):3035-3049doi: 10.19102/icrm.2018.090201.
Bui, A. H., & Waks, J. W. (2018). Risk Stratification of Sudden Cardiac Death After Acute Myocardial Infarction. The Journal of innovations in cardiac rhythm management, 9(2), 3035-3049. https://doi.org/10.19102/icrm.2018.090201
Bui, An H, and Waks, Jonathan W. "Risk Stratification of Sudden Cardiac Death After Acute Myocardial Infarction." The Journal of innovations in cardiac rhythm management vol. 9,2 (2018): 3035-3049. doi: https://doi.org/10.19102/icrm.2018.090201
Bui AH, Waks JW. Risk Stratification of Sudden Cardiac Death After Acute Myocardial Infarction. J Innov Card Rhythm Manag. 2018 Feb 15;9(2):3035-3049. doi: 10.19102/icrm.2018.090201. eCollection 2018 Feb. PMID: 32477797; PMCID: PMC7252689.
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J Innov Card Rhythm Manag. 2018 Feb 15;9(2):3035-3049. doi: 10.19102/icrm.2018.090201. eCollection 2018 Feb.

Risk Stratification of Sudden Cardiac Death After Acute Myocardial Infarction.

The Journal of innovations in cardiac rhythm management

An H Bui, Jonathan W Waks

Affiliations

  1. Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.

PMID: 32477797 PMCID: PMC7252689 DOI: 10.19102/icrm.2018.090201

Abstract

Despite advances in the diagnosis and treatment of acute coronary syndromes and an overall improvement in outcomes, mortality after myocardial infarction (MI) remains high. Sudden death, which is most frequently due to ventricular tachycardia or ventricular fibrillation, is the cause of death in 25% to 50% of patients with prior MI, and therefore represents an important public health problem. Use of the implantable cardioverter-defibrillator (ICD), which is the primary method of reducing the chance of arrhythmic sudden death after MI, is costly to the medical system and is associated with procedural and long-term risks. Additionally, assessment of left ventricular ejection fraction (LVEF), which is the primary method of assessing a patient's post-MI sudden death risk and appropriateness for ICD implantation, lacks both sensitivity and specificity for sudden death, and may not be the optimal way to select the subgroup of post-MI patients who are most likely to benefit from ICD implantation. To optimally utilize ICDs, it is therefore critical to develop and prospectively validate sudden death risk stratification methods beyond measuring LVEF. A variety of tests that assess left ventricular systolic function/morphology, potential triggers for ventricular arrhythmias, ventricular conduction/repolarization, and autonomic tone have been proposed as sudden death risk stratification tools. Multivariable models have also been developed to assess the competing risks of arrhythmic and non-arrhythmic death so that ICDs can be utilized more effectively. This manuscript will review the epidemiology of sudden death after MI, and will discuss the current state of sudden death risk stratification in this population.

Copyright: © 2018 Innovations in Cardiac Rhythm Management.

Keywords: Myocardial infarction; risk stratification; sudden cardiac death

Conflict of interest statement

The authors report no conflicts of interest for the published content.

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