Predictors of sudden cardiac death change with time after myocardial infarction: results from the VALIANT trial.


Journal Article

AIMS: To determine whether predictors of sudden cardiac death (SCD) vary with time after myocardial infarction (MI). METHODS AND RESULTS: We analysed 11 256 patients enrolled in VALIANT. Landmark analysis and Cox proportional hazards modelling were used to predict SCD during hospitalization, from discharge to 30 days, 30 days to 6 months, and 6 months to 3 years. The cumulative incidence of SCD was 8.6% (n = 965). Initially, higher baseline heart rate [HR 1.20 per 10 b.p.m. (95% CI 1.06-1.37)] and impaired baseline creatinine clearance [HR 0.82 per 10 mL/min (95% CI 0.74-0.91)] were stronger predictors of SCD. With long-term follow-up, prior MI [HR 1.71 (95% CI 1.39-2.10)], initial left ventricular ejection fraction <40% [HR 0.67 per 10% (95% CI 0.58-0.78)], and recurrent cardiovascular events [HR 1.47 for rehospitalization (95% CI 1.17-1.86)] were more robust risk stratifiers for SCD. Atrial fibrillation post-MI was associated with an increased risk of SCD over the entire follow-up period. As time passed, the associations between baseline clinical characteristics and SCD decreased and time-updated assessments became more important. CONCLUSION: Predictors of SCD change with time after MI. Future studies of risk stratification for SCD should account for changes in these factors with time after MI.

Full Text

Duke Authors

Cited Authors

  • Piccini, JP; Zhang, M; Pieper, K; Solomon, SD; Al-Khatib, SM; Van de Werf, F; Pfeffer, MA; McMurray, JJV; Califf, RM; Velazquez, EJ

Published Date

  • January 2010

Published In

Volume / Issue

  • 31 / 2

Start / End Page

  • 211 - 221

PubMed ID

  • 19854729

Pubmed Central ID

  • 19854729

Electronic International Standard Serial Number (EISSN)

  • 1522-9645

Digital Object Identifier (DOI)

  • 10.1093/eurheartj/ehp425


  • eng

Conference Location

  • England