Peek, Niels, Hindricks, Gerhard, Akbarov, Artur, Tijssen, Jan G P, Jenkins, David A, Kapacee, Zoher, Parkes, Le Mai, van der Geest, Rob J, Longato, Enrico, Sprague, Daniel, Taleb, Youssef, Ong, Marcus, Miller, Christopher A, Shamloo, Alireza Sepehri, Albert, Christine, Barthel, Petra, Boveda, Serge, Braunschweig, Frieder, Johansen, Jens Brock, Cook, Nancy, de Chillou, Christian, Elders, Petra, Faxén, Jonas, Friede, Tim, Fusini, Laura, Gale, Chris P, Jarkovsky, Jiri, Jouven, Xavier, Junttila, Juhani, Kautzner, Josef, Kiviniemi, Antti, Kutyifa, Valentina, Leclercq, Christophe, Lee, Daniel C, Leigh, Jill, Lenarczyk, Radosław, Leyva-Leon, Francisco, Maeng, Michael, Manca, Andrea, Marijon, Eloi, Marschall, Ursula, Merino, Jose Luis, Mont, Lluis, Nielsen, Jens Cosedis, Olsen, Thomas, Pester, Julie, Pontone, Gianluca, Roca, Ivo, Schmidt, Georg, Schwartz, Peter J, Sticherling, Christian, Suleiman, Mahmoud, Taborsky, Milos, Tan, Hanno L, Tfelt-Hansen, Jacob, Thiele, Holger, Tomaselli, Gordon F, Verstraelen, Tom, Vinayagamoorthy, Manickavasagar, Olesen, Kevin Kris Warnakula, Wilde, Arthur, Willems, Rik, Wu, Katherine C, Zabel, Markus, Martin, Glen P and Dagres, Nikolaos (2024). Sudden cardiac death after myocardial infarction: individual participant data from pooled cohorts. European Heart Journal ,
Abstract
Risk stratification of sudden cardiac death after myocardial infarction and prevention by defibrillator rely on left ventricular ejection fraction (LVEF). Improved risk stratification across the whole LVEF range is required for decision-making on defibrillator implantation. The analysis pooled 20 data sets with 140 204 post-myocardial infarction patients containing information on demographics, medical history, clinical characteristics, biomarkers, electrocardiography, echocardiography, and cardiac magnetic resonance imaging. Separate analyses were performed in patients (i) carrying a primary prevention cardioverter-defibrillator with LVEF ≤ 35% [implantable cardioverter-defibrillator (ICD) patients], (ii) without cardioverter-defibrillator with LVEF ≤ 35% (non-ICD patients ≤ 35%), and (iii) without cardioverter-defibrillator with LVEF > 35% (non-ICD patients >35%). Primary outcome was sudden cardiac death or, in defibrillator carriers, appropriate defibrillator therapy. Using a competing risk framework and systematic internal-external cross-validation, a model using LVEF only, a multivariable flexible parametric survival model, and a multivariable random forest survival model were developed and externally validated. Predictive performance was assessed by random effect meta-analysis. There were 1326 primary outcomes in 7543 ICD patients, 1193 in 25 058 non-ICD patients ≤35%, and 1567 in 107 603 non-ICD patients >35% during mean follow-up of 30.0, 46.5, and 57.6 months, respectively. In these three subgroups, LVEF poorly predicted sudden cardiac death (c-statistics between 0.50 and 0.56). Considering additional parameters did not improve calibration and discrimination, and model generalizability was poor. More accurate risk stratification for sudden cardiac death and identification of low-risk individuals with severely reduced LVEF or of high-risk individuals with preserved LVEF was not feasible, neither using LVEF nor using other predictors. [Abstract copyright: © The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.]
Publication DOI: | https://doi.org/10.1093/eurheartj/ehae326 |
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Divisions: | College of Health & Life Sciences > School of Biosciences College of Health & Life Sciences College of Health & Life Sciences > Aston Medical School > Translational Medicine Research Group (TMRG) College of Health & Life Sciences > Aston Medical School Aston University (General) |
Funding Information: | This project has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No. 847999. |
Additional Information: | Copyright © The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited. |
Uncontrolled Keywords: | Myocardial infarction,Primary prevention,Implantable cardioverter-defibrillator,Sudden cardiac death |
Publication ISSN: | 1522-9645 |
Last Modified: | 21 Nov 2024 08:23 |
Date Deposited: | 05 Nov 2024 18:42 |
Full Text Link: | |
Related URLs: |
https://academi ... ehae326/7815795
(Publisher URL) |
PURE Output Type: | Article |
Published Date: | 2024-10-08 |
Published Online Date: | 2024-10-08 |
Accepted Date: | 2024-05-12 |
Submitted Date: | 2023-10-02 |
Authors: |
Peek, Niels
Hindricks, Gerhard Akbarov, Artur Tijssen, Jan G P Jenkins, David A Kapacee, Zoher Parkes, Le Mai van der Geest, Rob J Longato, Enrico Sprague, Daniel Taleb, Youssef Ong, Marcus Miller, Christopher A Shamloo, Alireza Sepehri Albert, Christine Barthel, Petra Boveda, Serge Braunschweig, Frieder Johansen, Jens Brock Cook, Nancy de Chillou, Christian Elders, Petra Faxén, Jonas Friede, Tim Fusini, Laura Gale, Chris P Jarkovsky, Jiri Jouven, Xavier Junttila, Juhani Kautzner, Josef Kiviniemi, Antti Kutyifa, Valentina Leclercq, Christophe Lee, Daniel C Leigh, Jill Lenarczyk, Radosław Leyva-Leon, Francisco Maeng, Michael Manca, Andrea Marijon, Eloi Marschall, Ursula Merino, Jose Luis Mont, Lluis Nielsen, Jens Cosedis Olsen, Thomas Pester, Julie Pontone, Gianluca Roca, Ivo Schmidt, Georg Schwartz, Peter J Sticherling, Christian Suleiman, Mahmoud Taborsky, Milos Tan, Hanno L Tfelt-Hansen, Jacob Thiele, Holger Tomaselli, Gordon F Verstraelen, Tom Vinayagamoorthy, Manickavasagar Olesen, Kevin Kris Warnakula Wilde, Arthur Willems, Rik Wu, Katherine C Zabel, Markus Martin, Glen P Dagres, Nikolaos |