Sudden cardiac death after myocardial infarction: individual participant data from pooled cohorts

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
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

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