1
|
Bellicini MG, Cersosimo A, Cerini M, Bontempi L, Curnis A, Arabia G. ICD early after myocardial infarction: it is really necessary to wait 40 days before implantation? J Interv Card Electrophysiol 2024; 67:439-441. [PMID: 38099975 DOI: 10.1007/s10840-023-01711-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 11/26/2023] [Indexed: 04/14/2024]
Abstract
ESC Guidelines don't recommend ICD implantation within 40 days after MI, on the basis of old evidence with several limitations. However, a significant number of patients remain at high risk of arrhythmic death also in the early period after ACS, in these patients early ICD implantation or LifeVest may be use with benefit on survival.
Collapse
Affiliation(s)
- Maria Giulia Bellicini
- Cardiology Department, Department of Molecular and Translational Medicine, Spedali Civili Hospital, University of Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy
| | - Angelica Cersosimo
- Cardiology Department, Department of Molecular and Translational Medicine, Spedali Civili Hospital, University of Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy
| | - Manuel Cerini
- Cardiology Department, Department of Molecular and Translational Medicine, Spedali Civili Hospital, University of Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy
| | - Luca Bontempi
- Unit of Cardiology, Cardiac Electrophysiology and, Electrostimulation Laboratory, Bolognini" Hospital of Seriate - ASST Bergamo Est, Bergamo, Italy
| | - Antonio Curnis
- Cardiology Department, Department of Molecular and Translational Medicine, Spedali Civili Hospital, University of Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy
- Department of Molecular and Translational Medicine, University of Brescia, 25123, Brescia, Italy
| | - Gianmarco Arabia
- Cardiology Department, Department of Molecular and Translational Medicine, Spedali Civili Hospital, University of Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy.
- Department of Molecular and Translational Medicine, University of Brescia, 25123, Brescia, Italy.
| |
Collapse
|
2
|
Jaiswal V, Taha AM, Joshi A, Deb N, Kanagala SG, Nebuwa C, Ang SP, Halder A, Rajak K, Jha M, Pallath Harshakumar S, Mattumpuram J. Implantable cardioverter defibrillators for primary prevention in patients with ischemic and non-ischemic cardiomyopathy: A meta-analysis. Curr Probl Cardiol 2024; 49:102198. [PMID: 37952790 DOI: 10.1016/j.cpcardiol.2023.102198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 11/09/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND Ischemic and nonischemic cardiomyopathy (NICM) are one of the leading causes of sudden cardiac death (SCD). Evidence supporting Implantable Cardioverter Defibrillator (ICD) for the prevention of SCD and mortality has shown conflicting results to date. OBJECTIVE We aim to evaluate the impact of ICD therapy with conventional care for the primary prevention of death of various causes in adults with ICM and NICM. METHODS We performed a systematic literature search on the electronic database for relevant articles from inception until 30th May 2023. Pooled odds ratios (OR) were calculated using a random effect model, and a p-value of <0.05 was considered statistically significant. RESULTS A total of 13 randomized controlled trials involving 7857 patients were included in the study. Pooled analysis showed that ICD therapy was associated with a significant reduction in the incidence of all-cause mortality (OR, 0.69 (95%CI:0.55-0.87), P = 0.001), with a similar trend among ICM and NICM compared with the control group. ICD therapy also reduces the incidence of SCD (OR, 0.32(95%CI: 0.24-0.43), P<0.00001) with a similar trend in ICM and NICM, as well as death due to arrhythmia (OR, 0.35(95%CI: 0.19-0.64), P<0.001). However, the incidence of cardiovascular mortality in the ICD group (OR, 0.77(95%CI: 0.58-1.02), P=0.07) was comparable to the control group. CONCLUSION ICD therapy was associated with a reduction in the incidence of all-cause mortality, sudden cardiac death, and death due to arrhythmia among ischemic and nonischemic cardiomyopathy patients.
Collapse
Affiliation(s)
- Vikash Jaiswal
- Department of Cardiology Research, Larkin Community Hospital, South Miami, FL, United States
| | | | - Amey Joshi
- Department of Internal Medicine, Michigan State University-Sparrow Hospital, United States
| | - Novonil Deb
- North Bengal Medical College and Hospital, India
| | - Sai Gautham Kanagala
- Department of Internal Medicine, Metropolitan Hospital Center, NY, New York, United States
| | - Chikodili Nebuwa
- Department of Internal Medicine, Nuvance Health, Poughkeepsie, NewYork, United States
| | - Song Peng Ang
- Department of Internal Medicine, Rutgers Health/Community Medical Center, New Jersey, United States
| | - Anupam Halder
- Department of Internal Medicine, UPMC Harrisburg, PA, United States
| | - Kripa Rajak
- Department of Internal Medicine, UPMC Harrisburg, PA, United States
| | - Mayank Jha
- Department of Medicine and Surgery, Government Medical College, Surat, India
| | | | - Jishanth Mattumpuram
- Division of Cardiology, University of Louisville School of Medicine, KY 40202, United States.
| |
Collapse
|
3
|
Pezzato A, Fabris E, Gregorio C, Cittar M, Contessi S, Carriere C, Lardieri G, Zecchin M, Perkan A, Sinagra G. Implantable-cardioverter-defibrillator after ST-elevation myocardial infarction: when and how frequently is it implanted and what is the rate of appropriate interventions? Insight from Trieste registry. J Cardiovasc Med (Hagerstown) 2023; 24:871-879. [PMID: 37851355 DOI: 10.2459/jcm.0000000000001565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
BACKGROUND There are limited data on implantable-cardioverter-defibrillator (ICD) implantation after ST-elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (pPCI). Therefore, we evaluated when and how frequently an ICD is implanted after pPCI, the rate of appropriate ICD interventions, and predictors of ICD implantation. METHODS We analyzed STEMI patients treated with pPCI at the University Hospital of Trieste, Italy, between January 2010 and December 2019. We cross-matched patients' data with those present in the Trieste ICD registry. RESULTS Among 1805 consecutive patients treated with pPCI, 3.6% underwent ICD implantation during a median follow-up of 6.7 [interquartile range (IQR) 4.3-9.2] years. At 12 months, the mean number of ICD implantations was 2.3/100 patients [95% confidence interval (95% CI) 1.7-3.1] and remained stable over time (at 24 months: 2.5/100 patients, 95% CI 2.0-3.5 and at 36 months: 2.6/100 patients, 95% CI 2.3-3.8); 83.1% of ICDs were implanted for primary prevention, and more than half (55%) were implanted in patients with ejection fraction more than 35% at the moment of STEMI discharge. The rate of appropriate ICD interventions was 16.9% at a median follow-up of 5.7 years (IQR 3.3-8.3 years) after ICD implantation. At 12 months, the mean number of appropriate ICD interventions was 5/100 patients and 7/100 patients after 24 months. In patients with ejection fraction more than 35% at STEMI discharge (median ejection fraction 43%; IQR 40-48), independent predictors of ICD implantation were male sex, anterior STEMI and troponin peak more than 100 000 ng/dl. CONCLUSION The rate of ICD implantations after pPCI is low; however, the rate of appropriate ICD interventions is high. A relevant subgroup of patients received ICD implantations at follow-up despite a nonsevere ejection fraction at discharge after STEMI. Among these patients, those with high troponin release deserve strict follow-up and full optimal medical treatment.
Collapse
Affiliation(s)
| | | | - Caterina Gregorio
- Biostatistics Unit, Department of Medical Sciences, University of Trieste, Trieste
- MOX - Modeling and Scientific Computing Laboratory, Department of Mathematics, Politecnico di Milano, Milan
| | | | | | | | - Gerardina Lardieri
- Emergency Department, Division of Cardiology, Gorizia & Monfalcone Hospital, ASUGI, Trieste, Italy
| | | | | | | |
Collapse
|
4
|
Romano LR, Spaccarotella CAM, Indolfi C, Curcio A. Revascularization and Left Ventricular Dysfunction for ICD Eligibility. Life (Basel) 2023; 13:1940. [PMID: 37763344 PMCID: PMC10533106 DOI: 10.3390/life13091940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 09/17/2023] [Accepted: 09/19/2023] [Indexed: 09/29/2023] Open
Abstract
Common triggers for sudden cardiac death (SCD) are transient ischemia, hemodynamic fluctuations, neurocardiovascular influences, and environmental factors. SCD occurs rapidly when sinus rhythm degenerates into ventricular tachycardia (VT) and/or ventricular fibrillation (VF), followed by asystole. Such progressive worsening of the cardiac rhythm is in most cases observed in the setting of ischemic heart disease and often associated with advanced left ventricular (LV) impairment. Revascularization prevents negative outcomes including SCD and heart failure (HF) due to LV dysfunction (LVD). The implantable cardioverter-defibrillator (ICD) on top of medical therapy is superior to antiarrhythmic drugs for patients with LVD and VT/VF. The beneficial effects of ICD have been demonstrated in primary prevention of SCD as well. However, yet debated is the temporal management for patients with LVD who are eligible to ICD prior to revascularization, either through percutaneous or surgical approach. Restoration of coronary blood flow has a dramatic impact on adverse LV remodeling, while it requires aggressive long-term antiplatelet therapy, which might increase complication for eventual ICD procedure when percutaneous strategy is pursued; on the other hand, when LV and/or multiorgan dysfunction is present and coronary artery bypass grafting is chosen, the overall risk is augmented, mostly in HF patients. The aims of this review are to describe the pathophysiologic benefits of revascularization, the studies addressing percutaneous, surgical or no revascularization and ICD implantation, as well as emerging defibrillation strategies for patients deemed at transient risk of SCD and/or at higher risk for transvenous ICD implantation.
Collapse
Affiliation(s)
- Letizia Rosa Romano
- Division of Cardiology, Department of Medical and Surgical Sciences, Magna Graecia University, 88100 Catanzaro, Italy
| | | | - Ciro Indolfi
- Division of Cardiology, Department of Medical and Surgical Sciences, Magna Graecia University, 88100 Catanzaro, Italy
| | - Antonio Curcio
- Division of Cardiology, Department of Medical and Surgical Sciences, Magna Graecia University, 88100 Catanzaro, Italy
| |
Collapse
|
5
|
Luo L, Zhao C, Chen N, Dong Y, Li Z, Bai Y, Wu P, Gao C, Guo X. Characterization of global research trends and prospects on sudden coronary death: A literature visualization analysis. Heliyon 2023; 9:e18586. [PMID: 37576229 PMCID: PMC10413084 DOI: 10.1016/j.heliyon.2023.e18586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 07/12/2023] [Accepted: 07/21/2023] [Indexed: 08/15/2023] Open
Abstract
Background Sudden coronary death is a major global public health issue that has a significant impact on both individuals and society. Nowadays, scholars are active in sudden coronary death all over the world. However, no relevant bibliometric studies have been published. Here, we aim to gain a better understanding the current state of research and to explore potential new research directions through bibliometric analysis. Methods Articles and reviews on sudden coronary death from 2012 to 2023 were retrieved from the Web of Science Core Collection (WoSCC). The topic search was conducted using the following keywords: ((("sudden cardiac death" OR "sudden death") AND (coronary OR "myocardial infarction")) OR "sudden coronary death"). Knowledge maps of authors, countries, institutions, journals, keywords, and citations were conducted by CiteSpace. Publication dynamics, hotspots, and frontiers were analyzed independently by authors. Results A total of 2914 articles were identified from January 1, 2012 to June 20, 2023. The USA (n = 972) contributed the greatest absolute productivity and UK (centrality = 0.13) built a robust global collaboration. Harvard University was the institution with the highest number of publications (n = 143). Huikuri HV and Junttila MJ were the most published authors who devoted to searching for biomarkers of sudden coronary death. American Journal of Cardiology was the journal with the most publications, and Circulation was the most cited journal. Left ventricular ejection fraction, society, inflammation, and fractional flow reserve became novel burst words that lasted until 2023. Research on etiology and pathology, role of early risk factors in risk stratification, potential predictive biomarkers and novel measurement methods for the prevention and management of sudden coronary death were identified as the research hotspots and frontiers. Conclusion Our knowledge and understanding of sudden coronary death have significantly improved. Ongoing efforts should focus on the various etiologies and pathologies of sudden coronary death. Furthermore, a novel sudden coronary death risk model, large-scale population studies, and the rational use of multiple indicators to individualize the assessment of sudden coronary death and other risk factors are other emerging research trends.
Collapse
Affiliation(s)
- Li Luo
- Department of Pathology, School of Forensic Medicine, Shanxi Medical University, Taiyuan, China
| | - Chunmei Zhao
- Department of Pathology, School of Forensic Medicine, Shanxi Medical University, Taiyuan, China
| | - Niannian Chen
- Department of Pathology, School of Forensic Medicine, Shanxi Medical University, Taiyuan, China
| | - Yiming Dong
- Department of Pathology, School of Forensic Medicine, Shanxi Medical University, Taiyuan, China
| | - Zhanpeng Li
- Department of Pathology, School of Forensic Medicine, Shanxi Medical University, Taiyuan, China
| | - Yaqin Bai
- Department of Pathology, School of Forensic Medicine, Shanxi Medical University, Taiyuan, China
| | - Peng Wu
- Department of Pathology, School of Forensic Medicine, Shanxi Medical University, Taiyuan, China
| | - Cairong Gao
- Department of Pathology, School of Forensic Medicine, Shanxi Medical University, Taiyuan, China
| | - Xiangjie Guo
- Department of Pathology, School of Forensic Medicine, Shanxi Medical University, Taiyuan, China
| |
Collapse
|
6
|
Choi Y, Lee KY, Kim SH, Kim KA, Hwang BH, Choo EH, Lim S, Kim CJ, Kim JJ, Byeon J, Oh GC, Jeon DS, Yoo KD, Park HW, Kim MC, Ahn Y, Ho Jeong M, Hwang Y, Chang K. Predictors for early cardiac death after discharge from successfully treated acute myocardial infarction. Front Med (Lausanne) 2023; 10:1165400. [PMID: 37396907 PMCID: PMC10310993 DOI: 10.3389/fmed.2023.1165400] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 04/26/2023] [Indexed: 07/04/2023] Open
Abstract
Background The use of a cardioverter defibrillator for the primary prevention of sudden cardiac death is not recommended within 40 days after acute myocardial infarction (AMI). We investigated the predictors for early cardiac death among patients who were admitted for AMI and successfully discharged. Methods Consecutive patients with AMI were enrolled in a multicenter prospective registry. Among 10,719 patients with AMI, 554 patients with in-hospital death and 62 patients with early non-cardiac death were excluded. Early cardiac death was defined as a cardiac death within 90 days after index AMI. Results Early cardiac death after discharge occurred in 168/10,103 (1.7%) patients. A defibrillator was not implanted in all patients with early cardiac death. Killip class ≥3, chronic kidney disease stage ≥4, severe anemia, cardiopulmonary support usage, no dual antiplatelet therapy at discharge, and left ventricular ejection fraction (LVEF) ≤35% were independent predictors for early cardiac death. The incidence of early cardiac death according to the number of factors added to LVEF criteria in each patient was 3.03% for 0 factor, 8.11% for 1 factor, and 9.16% for ≥2 factors. Each model that sequentially added the factors in the presence of LVEF criteria showed a significant gradual increase in predictive accuracy and an improvement in reclassification capability. A model with all factors showed C-index 0.742 [95% CI 0.702-0.781], p < 0.001; IDI 0.024 [95% CI 0.015-0.033], p < 0.001; and NRI 0.644 [95% CI 0.492-0.795], p < 0.001. Conclusion We identified six predictors for early cardiac death after discharge from AMI. These predictors would help to discriminate high-risk patients over current LVEF criteria and to provide an individualized therapeutic approach in the subacute stage of AMI.
Collapse
Affiliation(s)
- Young Choi
- Cardiovascular Center and Cardiology Division, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
- Cardiovascular Research Institute for Intractable Disease, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Kwan Yong Lee
- Cardiovascular Center and Cardiology Division, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
- Cardiovascular Research Institute for Intractable Disease, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sang Hyun Kim
- Cardiovascular Center and Cardiology Division, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Kyung An Kim
- Cardiovascular Center and Cardiology Division, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Byung-Hee Hwang
- Cardiovascular Center and Cardiology Division, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Eun Ho Choo
- Cardiovascular Center and Cardiology Division, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sungmin Lim
- Cardiovascular Center and Cardiology Division, Uijeongbu St. Mary's Hospital, The Catholic University of Korea, Uijeongbu, Republic of Korea
| | - Chan Jun Kim
- Cardiovascular Center and Cardiology Division, Uijeongbu St. Mary's Hospital, The Catholic University of Korea, Uijeongbu, Republic of Korea
| | - Jin-Jin Kim
- Cardiovascular Center and Cardiology Division, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jaeho Byeon
- Cardiovascular Center and Cardiology Division, Incheon St. Mary's Hospital, The Catholic University of Korea, Incheon, Republic of Korea
| | - Gyu Chul Oh
- Cardiovascular Center and Cardiology Division, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Doo Soo Jeon
- Cardiovascular Center and Cardiology Division, Incheon St. Mary's Hospital, The Catholic University of Korea, Incheon, Republic of Korea
| | - Ki Dong Yoo
- Cardiovascular Center and Cardiology Division, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Republic of Korea
| | - Ha-Wook Park
- Department of Cardiology, Bucheon Sejong Hospital, Bucheon, Republic of Korea
| | - Min Chul Kim
- Department of Cardiology, Cardiovascular Center, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Youngkeun Ahn
- Department of Cardiology, Cardiovascular Center, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Myung Ho Jeong
- Department of Cardiology, Cardiovascular Center, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Youngdeok Hwang
- Paul H. Chook Department of Information Systems and Statistics, Baruch College, City University of New York, New York, NY, United States
| | - Kiyuk Chang
- Cardiovascular Center and Cardiology Division, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
- Cardiovascular Research Institute for Intractable Disease, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| |
Collapse
|
7
|
Nakamaru R, Shiraishi Y, Niimi N, Ueda I, Ikemura N, Suzuki M, Noma S, Inohara T, Numasawa Y, Fukuda K, Kohsaka S. Time Trend in Incidence of Sudden Cardiac Death After Percutaneous Coronary Intervention from 2009 to 2017 (from the Japanese Multicenter Registry). Am J Cardiol 2023; 188:44-51. [PMID: 36470011 DOI: 10.1016/j.amjcard.2022.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 10/14/2022] [Accepted: 11/10/2022] [Indexed: 12/12/2022]
Abstract
The advances in the integrated management of patients with coronary artery disease undergoing percutaneous coronary intervention (PCI) have reduced subsequent cardiovascular events. Nonetheless, sudden cardiac death (SCD) remains a major concern. Therefore, we aimed to investigate the time trend in SCD incidence after PCI and to identify the clinical factors contributing to SCD. From a prospective, multicenter cohort registry in Japan, 8,723 consecutive patients with coronary artery disease undergoing PCI between 2009 and 2017 were included. We evaluated the SCD incidence 2 years after PCI; all death events were adjudicated, and SCD was defined as unexpected death without a noncardiovascular cause in a previously stable patient within 24 hours from the onset. The Fine and Gray method was used to identify the factors associated with SCD. Overall, the mean age of the patients was 68.3 ± 11.3 years, and 1,173 patients (13.4%) had heart failure (HF). During the study period, the use of second-generation drug-eluting stents increased. The 2-year cumulative incidence of all-cause mortality and SCD was 4.29% and 0.45%, respectively. All-cause mortality remained stable during the study period (p for trend = 0.98), whereas the crude incidence of SCD tended to decrease over the study period (p for trend = 0.052). HF was the strongest predictor associated with the risk of SCD (crude incidence [vs non-HF] 2.13% vs 0.19%; p <0.001). In conclusion, the incidence of SCD after PCI decreased over the last decade, albeit the high incidence of SCD among patients with HF remains concerning.
Collapse
Affiliation(s)
- Ryo Nakamaru
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan; Healthcare Quality Assessment, the University of Tokyo, Tokyo, Japan
| | - Yasuyuki Shiraishi
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Nozomi Niimi
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Ikuko Ueda
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Nobuhiro Ikemura
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Masahiro Suzuki
- Department of Cardiology National Hospital Organization Saitama Hospital, Saitama, Japan
| | - Shigetaka Noma
- Department of Cardiology Saiseikai Utsunomiya Hospital, Tochigi, Japan
| | - Taku Inohara
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Yohei Numasawa
- Department of Cardiology Japanese Red Cross Ashikaga Hospital, Tochigi, Japan
| | - Keiichi Fukuda
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan.
| |
Collapse
|
8
|
Machado GP, Theobald AL, de Araujo GN, da Silveira AD, Wainstein RV, Fracasso JF, Niches M, Chies A, Goncalves SC, Pimentel M, Wainstein MV. Pre-percutaneous coronary intervention sudden cardiac arrest in ST-elevation myocardial infarction: Incidence, predictors, and related outcomes. Front Cardiovasc Med 2023; 10:1100187. [PMID: 36873399 PMCID: PMC9978146 DOI: 10.3389/fcvm.2023.1100187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 01/09/2023] [Indexed: 02/18/2023] Open
Abstract
Background ST-segment elevation myocardial infarction (STEMI) is a frequent cause of sudden cardiac arrest (SCA) and early percutaneous coronary intervention (PCI) is associated with increased survival. Despite constant improvements in SCA management, survival remains poor. We aimed to assess pre-PCI SCA incidence and related outcomes in patients admitted with STEMI. Methods This was a prospective cohort study of patients admitted with STEMI in a tertiary university hospital over 11 years. All patients were submitted to emergency coronary angiography. Baseline characteristics, details of the procedure, reperfusion strategies, and adverse outcomes were assessed. The primary outcome was in-hospital mortality. The secondary outcome was 1-year mortality after hospital discharge. Predictors of pre-PCI SCA was also assessed. Results During the study period 1,493 patients were included; the mean age was 61.1 years (±12), and 65.3% were male. Pre-PCI SCA was present in 133 (8.9%) patients. In-hospital mortality was higher in the pre-PCI SCA group (36.8% vs. 8.8%, p < 0.0001). In multivariate analysis, anterior MI, cardiogenic shock, age, pre-PCI SCA and lower ejection fraction remained significantly associated with in-hospital mortality. When we analyzed the interaction between pre-PCI SCA and cardiogenic shock upon admission there is a further increase in mortality risk when both conditions are present. For predictors of pre-PCI SCA, only younger age and cardiogenic shock remained significantly associated after multivariate analysis. Overall 1-year mortality rates were similar between pre-PCI SCA survivors and non-pre-PCI SCA group. Conclusion In a cohort of consecutive patients admitted with STEMI, pre-PCI SCA was associated with higher in-hospital mortality, and its association with cardiogenic shock further increases mortality risk. However, long-term mortality among pre-PCI SCA survivors was similar to non-SCA patients. Understanding characteristics associated with pre-PCI SCA may help to prevent and improve the management of STEMI patients.
Collapse
Affiliation(s)
- Guilherme Pinheiro Machado
- Postgraduate Program in Health Sciences: Cardiology and Cardiovascular Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Department of Cardiology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Andre Luiz Theobald
- Postgraduate Program in Health Sciences: Cardiology and Cardiovascular Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Department of Cardiology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Gustavo Neves de Araujo
- Imperial Hospital de Caridade, Florianópolis, Brazil.,Instituto de Cardiologia de Santa Catarina, São Jose, Brazil
| | - Anderson Donelli da Silveira
- Postgraduate Program in Health Sciences: Cardiology and Cardiovascular Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Department of Cardiology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Rodrigo Vugman Wainstein
- Postgraduate Program in Health Sciences: Cardiology and Cardiovascular Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Department of Cardiology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | | | - Matheus Niches
- School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Angelo Chies
- School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Sandro Cadaval Goncalves
- Postgraduate Program in Health Sciences: Cardiology and Cardiovascular Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Department of Cardiology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Mauricio Pimentel
- Postgraduate Program in Health Sciences: Cardiology and Cardiovascular Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Department of Cardiology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Marco Vugman Wainstein
- Postgraduate Program in Health Sciences: Cardiology and Cardiovascular Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Department of Cardiology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| |
Collapse
|
9
|
Grytsay ON, Skybchyk YV, Shorikova DV, Shorikov EI. CLINICAL CASES OF LIFE-THREATENING ARRHYTHMIAS: LONG AND SHORT QT SYNDROMES. WIADOMOSCI LEKARSKIE (WARSAW, POLAND : 1960) 2022; 75:1805-1812. [PMID: 35962703 DOI: 10.36740/wlek202207113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE The aim: To present clinical cases of sudden cardiac death in patients with prolonged and shortened QT interval. PATIENTS AND METHODS Materials and methods: The study includes description of two different clinical cases with prolonged and shortened QT interval after sudden cardiac death. Verification of the diagnosis was performed using the criteria recommended by the European Society of Cardiology (ESC) and European Heart Rhythm Association (EHRA). RESULTS Clinical case: Two clinical cases of syncopе with life-threatening arrhythmias, confirmed by electrocardiographic and clinical diagnostic criteria, indicating a change in the dispersion of the QT interval, are presented. The first case represents a patient with intermittent syncope. The patient had previously had attacks of sudden palpitations with fainting. The patient came after another episode of syncope. Further follow-up revealed clinical and electrocardiographic signs of ventricular tachycardia paroxysm. Than the prolongation of the QT interval is set. In this clinical case, verification of QT prolongation syndrome was established in the elderly. Another clinical case is associated with QT syndrome, which remains difficult to diagnose. Such cases have been described relatively recently. The clinical picture of the syndrome of short QT interval in the presented clinical case was characterized by the appearance of syncopal states. The patient showed changes in the adjusted QT interval <320 ms. The causes of syncope in a patient with a short QT interval were paroxysms of atrial fibrillation (AF) or ventricular arrhythmias. At the same time the anatomical structure of a myocardium remains normal and unchanged. The hereditary nature of the disease in the patient has been proven. CONCLUSION Conclusions: Timely diagnosis of prolongation (LQTS) or shortening (SQTS) of the QT interval after ECG and Holter monitoring allows you to identify a group of patients with an increased risk of developing ventricular arrhythmias, syncope and sudden cardiac death. Implantation of a cardioverter-defibrillator is an effective and safe method of preventing sudden cardiac death in patients with long and short QT syndromes.
Collapse
Affiliation(s)
- Olexandr N Grytsay
- DEPARTMENT OF HEART RHYTHM DISORDERS, HEART INSTITUTE OF THE MINISTRY OF HEALTHCARE OF UKRAINE, KYIV, UKRAINE
| | - Yaroslav V Skybchyk
- DEPARTMENT OF HEART RHYTHM DISORDERS, HEART INSTITUTE OF THE MINISTRY OF HEALTHCARE OF UKRAINE, KYIV, UKRAINE
| | - Dina V Shorikova
- DEPARTMENT OF INTERNAL MEDICINE, CLINICAL PHARMACOLOGY AND OCCUPATIONAL DISEASES, BUKOVINIAN STATE MEDICAL UNIVERSITY, CHERNIVTSI, UKRAINE
| | - Eugene I Shorikov
- DEPARTMENT OF INTERNAL MEDICINE, CLINICAL PHARMACOLOGY AND OCCUPATIONAL DISEASES, BUKOVINIAN STATE MEDICAL UNIVERSITY, CHERNIVTSI, UKRAINE
| |
Collapse
|
10
|
Implantable Cardioverter Defibrillator in Primary and Secondary Prevention of SCD-What We Still Don't Know. J Cardiovasc Dev Dis 2022; 9:jcdd9040120. [PMID: 35448096 PMCID: PMC9028370 DOI: 10.3390/jcdd9040120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 04/04/2022] [Accepted: 04/14/2022] [Indexed: 12/07/2022] Open
Abstract
Implantable cardioverter defibrillators (ICDs) are the cornerstone of primary and secondary prevention of sudden cardiac death (SCD) all around the globe. In almost 40 years of technological advances and multiple clinical trials, there has been a continuous increase in the implantation rate. The purpose of this review is to highlight the grey areas related to actual ICD recommendations, focusing specifically on the primary prevention of SCD. We will discuss the still-existing controversies strongly reflected in the differences between the international guidelines regarding ICD indication class in non-ischemic cardiomyopathy, and also address the question of early implantation after myocardial infarction in the absence of clear protocols for patients at high risk of life-threatening arrhythmias. Correlating the insufficient data in the literature for 40-day waiting times with the increased risk of SCD in the first month after myocardial infarction, we review the pros and cons of early ICD implantation.
Collapse
|
11
|
Mueller‐Leisse J, Brunn J, Zormpas C, Hohmann S, Hillmann HAK, Eiringhaus J, Bauersachs J, Veltmann C, Duncker D. Extended follow-up after wearable cardioverter-defibrillator period: the PROLONG-II study. ESC Heart Fail 2021; 8:5142-5148. [PMID: 34480414 PMCID: PMC8712878 DOI: 10.1002/ehf2.13586] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 07/29/2021] [Accepted: 08/19/2021] [Indexed: 11/05/2022] Open
Abstract
AIM The wearable cardioverter-defibrillator (WCD) is used for temporary protection from sudden cardiac death (SCD) in patients with newly diagnosed heart failure with reduced ejection fraction before considering an implantable cardioverter-defibrillator (ICD). However, the prognostic significance of the WCD remains controversial due to conflicting evidence. The aim of the present study was to evaluate prognosis of patients receiving life-saving WCD shocks. METHODS AND RESULTS All patients receiving a WCD at Hannover Medical School for heart failure with reduced ejection fraction between 2012 and 2017 were included. Data were acquired at baseline, at 3 months and at last available follow-up (FU). Three hundred and fifty-three patients were included (69% male; age 56 ± 15 years; left ventricular ejection fraction 25 ± 8%). FU after the WCD was 2.8 ± 1.5 years with a maximum of 6.8 years. Daily WCD wear time was 22 ± 4 h. Fourteen patients (4%) received appropriate WCD shocks. Two patients (0.6%) died during the WCD period. Thirty patients (9%) died during extended FU. Mean estimated survival after the WCD was similar between patients with and without WCD shocks. Patients without an ICD recommendation after WCD prescription did not experience SCD during FU. CONCLUSIONS Patients with WCD shocks showed a favourable survival. Patients without an ICD recommendation after WCD prescription had no SCD during FU. These findings support the practice of careful risk stratification before considering an ICD and the use of the WCD for temporary protection from SCD.
Collapse
Affiliation(s)
- Johanna Mueller‐Leisse
- Hannover Heart Rhythm Center, Department of Cardiology and AngiologyHannover Medical SchoolCarl‐Neuberg‐Str. 1Hannover30625Germany
| | - Johanna Brunn
- Hannover Heart Rhythm Center, Department of Cardiology and AngiologyHannover Medical SchoolCarl‐Neuberg‐Str. 1Hannover30625Germany
| | - Christos Zormpas
- Hannover Heart Rhythm Center, Department of Cardiology and AngiologyHannover Medical SchoolCarl‐Neuberg‐Str. 1Hannover30625Germany
| | - Stephan Hohmann
- Hannover Heart Rhythm Center, Department of Cardiology and AngiologyHannover Medical SchoolCarl‐Neuberg‐Str. 1Hannover30625Germany
| | - Henrike Aenne Katrin Hillmann
- Hannover Heart Rhythm Center, Department of Cardiology and AngiologyHannover Medical SchoolCarl‐Neuberg‐Str. 1Hannover30625Germany
| | - Jörg Eiringhaus
- Hannover Heart Rhythm Center, Department of Cardiology and AngiologyHannover Medical SchoolCarl‐Neuberg‐Str. 1Hannover30625Germany
| | - Johann Bauersachs
- Hannover Heart Rhythm Center, Department of Cardiology and AngiologyHannover Medical SchoolCarl‐Neuberg‐Str. 1Hannover30625Germany
| | - Christian Veltmann
- Hannover Heart Rhythm Center, Department of Cardiology and AngiologyHannover Medical SchoolCarl‐Neuberg‐Str. 1Hannover30625Germany
| | - David Duncker
- Hannover Heart Rhythm Center, Department of Cardiology and AngiologyHannover Medical SchoolCarl‐Neuberg‐Str. 1Hannover30625Germany
| |
Collapse
|
12
|
Haanschoten D, Elvan A. The DAPA Trial in the Context of Previous Prophylactic ICD Landmark Trials. Arrhythm Electrophysiol Rev 2021; 10:154-158. [PMID: 34777819 PMCID: PMC8576491 DOI: 10.15420/aer.2021.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 07/28/2021] [Indexed: 12/04/2022] Open
Abstract
In patients with ischaemic cardiomyopathy and severely reduced left ventricular ejection fraction (LVEF), an arrhythmogenic milieu is created by a complex interplay between myocardial scarring (assessed by cardiac MRI) and multiple other factors (ventricular ectopy, ischaemia and autonomic imbalance), favouring the occurrence of arrhythmic sudden cardiac death (SCD). Currently, a dynamic and robust model of dichotomised SCD risk assessment after primary percutaneous coronary intervention (PCI) is lacking, underlining the urgent need for further refinement of the widely accepted and guidelines-based criteria (ischaemic cardiomyopathy, LVEF ≤35%) for primary prevention. This review addresses the potential additional value of the recently published Defibrillator After Primary Angioplasty (DAPA) trial results. The DAPA trial conveys important messages and provides novel perspectives regarding left ventricular function post-primary PCI as an (early) risk marker for SCD and the impact of prophylactic ICD implantation on survival in this cohort. In the context of other previous primary prevention trials, DAPA was the first trial including only ST-elevation MI patients all treated with acute PCI.
Collapse
Affiliation(s)
| | - Arif Elvan
- Heart Centre, Department of Cardiology, Isala Hospital, Zwolle, the Netherlands
| |
Collapse
|
13
|
Shah K, Shah S, Turagam MK, Bhardwaj R, Contractor T, Mandapati R, Natale A, Lakkireddy D, Garg J. Early Implantable Cardioverter-Defibrillator After Acute Myocardial Infarction. Am J Cardiol 2021; 152:170-172. [PMID: 34103156 DOI: 10.1016/j.amjcard.2021.04.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 04/27/2021] [Indexed: 11/25/2022]
|
14
|
Adabag S, Zimmerman P, Lexcen D, Cheng A. Predictors of Sudden Cardiac Arrest Among Patients With Post-Myocardial Infarction Ejection Fraction Greater Than 35. J Am Heart Assoc 2021; 10:e020993. [PMID: 34259015 PMCID: PMC8483475 DOI: 10.1161/jaha.121.020993] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Sudden cardiac arrest (SCA) risk increases after myocardial infarction (MI) in patients with a reduced ejection fraction (EF). However, the risk factors for SCA among patients with a post‐MI EF >35% remain poorly understood. Methods and Results Using the Optum de‐identified electronic health record data set from 2008 to 2017, we identified patients with an incident MI diagnosis and troponin elevation who had a post‐MI EF >35% and underwent coronary angiography. Primary outcome was SCA within 1 year post‐MI. The database was divided into derivation (70%) and validation (30%) cohorts by random selection. Cox proportional hazard regression was used to generate and validate a risk prediction model. Among 31 286 patients with an MI (median age 64.1; 39% female; 87% White), 499 experienced SCA within 1 year post‐MI (estimated probability 1.8%). Lack of revascularization at MI, post‐MI EF <50%, Black race, renal failure, chronic obstructive pulmonary disease, antiarrhythmic therapy, and absence of beta blocker therapy were independent predictors of SCA. A multivariable model consisting of these variables predicted SCA risk (C‐statistic 0.73). Based on this model, the estimated annual probability of SCA was 4.4% (95% CI, 3.9–4.9) in the highest quartile of risk versus 0.6% (95% CI, 0.4–0.8) in the lowest quartile. Conclusions Patients with a post‐MI EF >35% have a substantial annual risk of SCA. A risk model consisting of acute coronary revascularization, EF, race, renal failure, chronic obstructive pulmonary disease, antiarrhythmic therapy, and beta blocker therapy can identify patients with higher risk of SCA, who may benefit from further risk stratification and closer monitoring.
Collapse
Affiliation(s)
- Selçuk Adabag
- Division of Cardiology Minneapolis VA Health Care System Minneapolis MN.,Department of Medicine University of Minnesota Minneapolis MN
| | | | - Daniel Lexcen
- Cardiac Rhythm Heart FailureMedtronic, Inc. Minneapolis MN
| | - Alan Cheng
- Cardiac Rhythm Heart FailureMedtronic, Inc. Minneapolis MN
| |
Collapse
|
15
|
Sudden Cardiac Death in Patients with Heart Disease and Preserved Systolic Function: Current Options for Risk Stratification. J Clin Med 2021; 10:jcm10091823. [PMID: 33922111 PMCID: PMC8122448 DOI: 10.3390/jcm10091823] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 04/17/2021] [Accepted: 04/20/2021] [Indexed: 12/26/2022] Open
Abstract
Sudden cardiac death (SCD) is the leading cause of cardiovascular mortality in patients with coronary artery disease without severe systolic dysfunction and in heart failure with preserved ejection fraction. From a global health perspective, while risk may be lower, the absolute number of SCDs in patients with left ventricle ejection fraction >35% is higher than in those with severely reduced left ventricle ejection fraction (defined as ≤35%). Despite these observations and the high amount of available data, to date there are no clear recommendations to reduce the sudden cardiac death burden in the population with mid-range or preserved left ventricle ejection fraction. Ongoing improvements in risk stratification based on electrophysiological and imaging techniques point towards a more precise identification of patients who would benefit from ICD implantation, which is still an unmet need in this subset of patients. The aim of this review is to provide a state-of-the-art approach in sudden cardiac death risk stratification of patients with mid-range and preserved left ventricular ejection fraction and one of the following etiologies: ischemic cardiomyopathy, heart failure, atrial fibrillation or myocarditis.
Collapse
|
16
|
Parkash R, MacIntyre C, Dorian P. Predicting Sudden Cardiac Death After Myocardial Infarction: A Great Unsolved Challenge. Circ Arrhythm Electrophysiol 2021; 14:e009422. [PMID: 33464943 DOI: 10.1161/circep.120.009422] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Ratika Parkash
- Queen Elizabeth II Health Sciences Center, Halifax, Nova Scotia (R.P., C.M.)
| | - Ciorsti MacIntyre
- Queen Elizabeth II Health Sciences Center, Halifax, Nova Scotia (R.P., C.M.)
| | - Paul Dorian
- St Michael's Hospital, University of Toronto, ON, Canada (P.D.)
| |
Collapse
|