Comparison between Japan and North America in the post-hospital course after recovery from an acute coronary event

Introduction. There is little information on the specific risk factors leading to sudden cardiac death (SCD) during an acute coronary event, because the risk variables may overlap with those of non-fatal coronary event. This study was designed to compare the risk profiles of SCD victims and survivors of an acute coronary event. Methods and Results. A case-control study included consecutive victims of SCD (n=425, mean age 64±11 years) verified to be due to an acute coronary event at medicolegal autopsy and consecutive patients surviving an acute myocardial infarction (AMI, n=644, mean age 62±10 years). Common cardiovascular risk factors, cardiac hypertrophy, and severity of coronary artery disease (CAD) were assessed in both groups. Family history of SCD (odds ratio 1.5, 95% CI 1.0 to 2.2, p=0.03), male gender (odds ratio 1.8, 95% CI 1.3 to 2.4, p<0.001), current smoking (odds ratio 2.0, 95% CI 1.5 to 2.6, p<0.001), cardiac hypertrophy (odds ratio 3.0, 95% CI 2.3 to 3.9, p<0.001) and 3-vessel CAD (odds ratio 5.4, 95% CI 3.6 to 8.2, p<0.001) were more common among the victims of SCD as compared to survivors of AMI. On the contrary, history of hypercholesterolemia (p<0.001) was less common among the SCD victims. There was a cumulative increase of risk of being a SCD victim vs. AMI survivor when more than one risk factor was present, the odds ratio being 44.3 (95% CI 8.0 to 246.7) in a current male smoker with a family history of SCD and cardiac hypertrophy. When 3-vessel CAD was added to the combined risk score, all subjects (7% of the SCD victims) were in the group of SCD giving a 100% sensitivity and specificity, respectively, in differentiating between the SCD victims and AMI survivors. Conclusions. There are specific features that differentiate the victims of SCD from survivors of an acute coronary event. Clustering of several variables, such as family history of SCD, smoking, cardiac hypertrophy, and 3-vessel CAD indicate a very high risk of SCD.

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Should All Patients with an Acute Coronary Event or at High CHD Risk Be Started on High-Dose Statin Therapy?

Dyslipidemia: Contemporary Evaluation and Management eReport ◽

10.37573/9781585284719.034 ◽

2014 ◽

pp. 22-22

Keyword(s):

Statin Therapy ◽

Coronary Event ◽

High Dose ◽

Acute Coronary Event ◽

Chd Risk

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Severity of coronary artery disease, cardiac hypertrophy and coronary risk factors in victims of sudden cardiac death caused by an acute coronary event

International Journal of Cardiology ◽

10.1016/j.ijcard.2007.03.017 ◽

2007 ◽

Vol 119 ◽

pp. S6

Author(s):

Kari Kaikkonen ◽

Marja-Leena Kortelainen ◽

Heikki Huikuri

Keyword(s):

Risk Factors ◽

Coronary Artery Disease ◽

Coronary Artery ◽

Sudden Cardiac Death ◽

Cardiac Death ◽

Coronary Event ◽

Coronary Risk Factors ◽

Coronary Risk ◽

Acute Coronary Event ◽

Artery Disease

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Management and outcomes following an acute coronary event in patients with chronic heart failure 1999-2007

European Journal of Heart Failure ◽

10.1093/eurjhf/hfs041 ◽

2012 ◽

Vol 14 (5) ◽

pp. 464-472 ◽

Cited By ~ 9

Author(s):

Isuru Ranasinghe ◽

Chris Naoum ◽

Bernadette Aliprandi-Costa ◽

Andrew P. Sindone ◽

P. Gabriel Steg ◽

...

Keyword(s):

Heart Failure ◽

Chronic Heart Failure ◽

Coronary Event ◽

Acute Coronary Event

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P2661Ventricular fibrillation during acute STEMI is not associated with early repolarization pattern on ECG recorded prior to the index ischemic episode

European Heart Journal ◽

10.1093/eurheartj/ehz748.0981 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

M M Demidova ◽

J Carlson ◽

D Erlinge ◽

P G Platonov

Keyword(s):

Tertiary Care ◽

Coronary Event ◽

Acute Ischemia ◽

Care Hospital ◽

Acute Coronary Event ◽

Early Repolarization ◽

High Prevalence ◽

Ischemic Episode ◽

St Elevation ◽

Qrs Duration

Abstract Background Generally considered as benign, ECG early repolarization (ER) pattern was recently claimed to be an indicator of increased susceptibility to fatal arrhythmias during acute ischemia. The victims of sudden cardiac death have been reported to have high prevalence of ER comparing with survivors of acute coronary event. We aimed to test the association between the ER pattern on resting ECG recorded prior to ST-elevation myocardial infarction (STEMI) and the risk of ventricular fibrillation (VF) during acute phase of STEMI in non-selected population of STEMI patients. Methods For STEMI patients admitted to a tertiary care hospital for primary PCI during 2007–2010 (n=2286), all ECGs recorded prior to the date of admission with STEMI were extracted from a digital archive. The latest ECG recorded prior to the index STEMI was used for analysis. After excluding ECGs with paced rhythm and intraventricular blocks with QRS duration ≥120ms, the remaining ECGs were processed using the Glasgow algorithm allowing automatic ER detection. The association between ER-pattern on historical ECG and VF during the first 48 hours of STEMI was tested using logistic regression. Results Historical ECGs were available for 1584 patients; 124 of them were excluded due to a paced rhythm or wide QRS, leaving 1460 patients available for analysis (age 68±12 years, 67% male). The time from historical ECG to STEMI was 16 (IQR 4–49) months. ER pattern was present on historical ECG in 272 of 1460 (18.6%) (ER+ group), among them in 90 (33%) – in inferior leads, in 116 (43%) – in lateral leads, in 66 (24%) – both in inferior and lateral leads. ER+ patients were younger both at the time of historical ECG (64±13 vs 66±19; p=0.041) and at the time of STEMI (67±12 vs 68±12; p=0.033), and had lower heart rate on historical ECG (68±12 vs 73±15; p<0.001) than ER- patients. ER+ and ER- groups did not differ regarding clinical characteristics and conventional ECG measurements. The course of STEMI was complicated by VF in 106 patients (17 of them from ER+ group). The occurrence of VF during STEMI was not associated with ER-pattern on historical ECG (OR 0.875 95% CI 0.518–1.479; p=0.618). There was no association of ER pattern with VF before reperfusion (OR 0.54 95% CI 0.25–1.21; p=0.135) or reperfusion VF (OR 1.28 95% CI 0.55–3.01; p=0.569). No association was observed with regard to localization (inferior or lateral) of ER-pattern either. Conclusion In a non-selected population of STEMI patients the presence of ER-pattern on ECG recorded prior to the acute coronary event was not associated with VF during the first 48 hours of STEMI.

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