Death during acute myocardial infarction: dodging the first bullet.

摘要

Survivors of acute myocardial infarction (AMI) are an increased risk for death, particularly in the early post-AMI period when the cause of death is overwhelmingly cardiovascular in origin. Large studies have actually documented a significant clustering of deaths in the early post-AMI period, with declining levels over time reaching a steady state beyond 2 years of the index event. In the Valsartan in Acute Myocardial Infarction Trial (VALIANT), the rate of all-cause mortality in the immediate post-AMI phase was 1.4% per month, compared to 0.14% per month between years 2 and 3 after AMI. Depressed left ventricular function manifested by a low left ventricular ejection fraction (EF) was a major predictor of death in this population.Implantable cardioverter-defibrillators (ICDs) prolong life in patients with severe ischemic cardiomyopathy, primarily by reducing sudden cardiac death events related to malignant ventricular arrhythmias. In the Multicenter Automatic Defibrillator Implantation Trial (MADIT) II, which randomized survivors of myocardial infarction who had a severely depressed EF to ICD versus medical therapy, the mean time from the index myocardial infarction to randomization was greater than 6 years.