Cardiovascular Events and Long‐Term Risk of Sudden Death Among Stabilized Patients After Acute Coronary Syndrome: Insights From IMPROVE‐IT

Background Unlike patients with low ejection fraction after an acute coronary syndrome (ACS), little is known about the long-term incidence and influence of cardiovascular events before sudden death among stabilized patients after ACS. Methods and Results A total of 18 144 patients stabilized within...

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Vydané v:Journal of the American Heart Association Ročník 11; číslo 4; s. e022733
Hlavní autori: Fordyce, Christopher B., Giugliano, Robert P., Cannon, Christopher P., Roe, Matthew T., Sharma, Abhinav, Page, Courtney, White, Jennifer A., Lokhnygina, Yuliya, Braunwald, Eugene, Blazing, Michael A.
Médium: Journal Article
Jazyk:English
Vydavateľské údaje: England John Wiley and Sons Inc 15.02.2022
Wiley
Predmet:
Acute Coronary Syndrome - diagnosis
Acute Coronary Syndrome - epidemiology
Acute Coronary Syndrome - therapy
Death, Sudden, Cardiac - epidemiology
Death, Sudden, Cardiac - etiology
Ezetimibe, Simvastatin Drug Combination
Heart Failure - complications
Heart Failure - epidemiology
Humans
long‐term outcomes
myocardial infarction
Myocardial Infarction - complications
Myocardial Infarction - epidemiology
Original Research
Risk Factors
sudden death
Treatment Outcome
sudden death
long‐term outcomes
myocardial infarction
ISSN:2047-9980, 2047-9980
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Shrnutí:Background Unlike patients with low ejection fraction after an acute coronary syndrome (ACS), little is known about the long-term incidence and influence of cardiovascular events before sudden death among stabilized patients after ACS. Methods and Results A total of 18 144 patients stabilized within 10 days after ACS in IMPROVE-IT (Improved Reduction of Outcomes: Vytorin Efficacy International Trial) were studied. Cumulative incidence rates (IRs) and IRs per 100 patient-years of sudden death were calculated. Using Cox proportional hazards, the association of ≥1 additional postrandomization cardiovascular events (myocardial infarction, stroke, and hospitalization for unstable angina or heart failure) with sudden death was examined. Early (≤1 year after ACS) and late sudden deaths (>1 year) were compared. Of 2446 total deaths, 402 (16%) were sudden. The median time to sudden death was 2.7 years, with 109 early and 293 late sudden deaths. The cumulative IR was 2.47% (95% CI, 2.23%-2.73%) at 7 years of follow-up. The risk of sudden death following a postrandomization cardiovascular event (150/402 [37%] sudden deaths; median 1.4 years) was greater (IR/100 patient-years, 1.45 [95% CI, 1.23-1.69]) than the risk with no postrandomization cardiovascular event (IR/100 patient-years, 0.27 [95% CI, 0.24-0.30]). Postrandomization myocardial infarction (hazard ratio [HR], 3.64 [95% CI, 2.85-4.66]) and heart failure (HR, 4.55 [95% CI, 3.33-6.22]) significantly increased future risk of sudden death. Conclusions Patients stabilized within 10 days of an ACS remain at long-term risk of sudden death with the greatest risk in those with an additional cardiovascular event. These results refine the long-term risk and risk effectors of sudden death, which may help clinicians identify opportunities to improve care. Registration: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00202878.
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For Sources of Funding and Disclosures, see page 11.
Supplemental Material for this article is available at https://www.ahajournals.org/doi/suppl/10.1161/JAHA.121.022979
ISSN:2047-9980
2047-9980
DOI:10.1161/JAHA.121.022733