BACKGROUND The risk of sudden cardiac death (SCD) is high early after myocardial infarction (MI). Current knowledge and guidelines mainly rely on results from older clinical trials and registry studies. Left ventricular ejection fraction (LVEF) alone has not been proven a reliable predictor of SCD. OBJECTIVES This study sought to identify the incidence and additional predictors of SCD early after MI in a contemporary nationwide setting. METHODS The authors used data from SWEDEHEART, the Swedish Cardiopulmonary Resuscitation Registry, and the Swedish Pacemaker and Implantable Cardioverter-Defibrillator (ICD) Registry. Cases of MI, which had undergone coronary angiography and were discharged alive between 2009 to 2017 without a prior ICD, were followed up to 90 days. Cox regression models were used to assess associations between clinical parameters and out-of-hospital cardiac arrest (OHCA). RESULTS Among 121,379 cases, OHCA occurred in 349 (0.29%) and non-OHCA death in 2,194 (1.8%). A total of 6 variables (male sex, diabetes, estimated glomerular filtration rate <30 ml/min/1.73 m2, Killip class ≥II, new-onset atrial fibrillation/flutter, and impaired LVEF [reference ≥50%] categorized as 40% to 49%, 30% to 39%, and <30%) were identified as independent predictors, were assigned points, and were grouped into 3 categories, where the incidence of OHCA ranged from 0.12% to 2.0% and non-OHCA death from 0.76% to 11.7%. Stratified by LVEF <40% alone, the incidence of OHCA was 0.20% and 0.76% and for non-OHCA death 1.1% and 4.9%. CONCLUSIONS In this nationwide study, the incidence of OHCA within 90 days after MI was <0.3%. A total of 5 clinical parameters in addition to LVEF predicted OHCA and non-OHCA death better than LVEF alone.

中文翻译：

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心肌梗塞后 90 天内院外心脏骤停的发生率和预测因素

背景 心肌梗塞 (MI) 后早期发生心源性猝死 (SCD) 的风险很高。当前的知识和指南主要依赖于较早的临床试验和注册研究的结果。单独的左心室射血分数 (LVEF) 尚未被证明是 SCD 的可靠预测指标。目的 本研究旨在确定当代全国范围内 MI 后早期 SCD 的发生率和其他预测因素。方法 作者使用来自 SWEDEHEART、瑞典心肺复苏登记处以及瑞典起搏器和植入式心律转复除颤器 (ICD) 登记处的数据。2009 年至 2017 年间接受冠状动脉造影并在没有先前 ICD 的情况下出院的 MI 病例，随访时间长达 90 天。Cox 回归模型用于评估临床参数与院外心脏骤停 (OHCA) 之间的关联。结果 121,379 例中，OHCA 死亡 349 例（0.29%），非 OHCA 死亡 2,194 例（1.8%）。总共 6 个变量（男性、糖尿病、估计肾小球滤过率 <30 ml/min/1.73 m2、Killip 分级 ≥II、新发房颤/扑动和 LVEF 受损 [参考≥50%] 归类为 40%到 49%、30% 到 39% 和 <30%）被确定为独立预测因子，被分配点，并分为 3 类，其中 OHCA 的发生率为 0.12% 到 2.0%，非 OHCA 的死亡率为0.76% 至 11.7%。单独按 LVEF <40% 分层，OHCA 的发生率为 0.20% 和 0.76%，非 OHCA 的死亡率为 1.1% 和 4.9%。结论 在这项全国性研究中，MI 后 90 天内 OHCA 的发生率 <0.3%。除 LVEF 外，共有 5 个临床参数比单独的 LVEF 更能预测 OHCA 和非 OHCA 死亡。