Predictors for early cardiac death after discharge from successfully treated acute myocardial infarction

Young Choi; Kwan Yong Lee; Sang Hyun Kim; Kyung An Kim; Byung-Hee Hwang; Eun Ho Choo; Sungmin Lim; Chan Jun Kim; Jin-Jin Kim; Jaeho Byeon; Gyu Chul Oh; Doo Soo Jeon; Ki Dong Yoo; Ha-Wook Park; Min Chul Kim; Youngkeun Ahn; Myung Ho Jeong; Youngdeok Hwang; Kiyuk Chang

doi:10.3389/fmed.2023.1165400

Predictors for early cardiac death after discharge from successfully treated acute myocardial infarction

Front Med (Lausanne). 2023 Jun 15:10:1165400. doi: 10.3389/fmed.2023.1165400. eCollection 2023.

Authors

Young Choi^{1

2}, Kwan Yong Lee^{1

2}, Sang Hyun Kim¹, Kyung An Kim¹, Byung-Hee Hwang¹, Eun Ho Choo¹, Sungmin Lim³, Chan Jun Kim³, Jin-Jin Kim¹, Jaeho Byeon⁴, Gyu Chul Oh¹, Doo Soo Jeon⁴, Ki Dong Yoo⁵, Ha-Wook Park⁶, Min Chul Kim⁷, Youngkeun Ahn⁷, Myung Ho Jeong⁷, Youngdeok Hwang⁸, Kiyuk Chang^{1

2}

Affiliations

¹ Cardiovascular Center and Cardiology Division, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea.
² Cardiovascular Research Institute for Intractable Disease, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
³ Cardiovascular Center and Cardiology Division, Uijeongbu St. Mary's Hospital, The Catholic University of Korea, Uijeongbu, Republic of Korea.
⁴ Cardiovascular Center and Cardiology Division, Incheon St. Mary's Hospital, The Catholic University of Korea, Incheon, Republic of Korea.
⁵ Cardiovascular Center and Cardiology Division, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Republic of Korea.
⁶ Department of Cardiology, Bucheon Sejong Hospital, Bucheon, Republic of Korea.
⁷ Department of Cardiology, Cardiovascular Center, Chonnam National University Hospital, Gwangju, Republic of Korea.
⁸ Paul H. Chook Department of Information Systems and Statistics, Baruch College, City University of New York, New York, NY, United States.

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.

Keywords: cardiac; cardiogenic shock; death; heart failure; myocardial infarction; prognostic factors; sudden; systolic.