Predictors of sudden cardiac death in long-term follow-up in patients with ST-elevation myocardial infarction treated with primary percutaneous coronary intervention

Type of funding sources: None.

Despite timely and successful reperfusion tretment with primary percutaneous coronary intervention (pPCI), some patients have a high risk of mortality and SCD.

The aim of our study was to analyze the incidence of SCD and determine the predictors of SCD occurrence during 6-year follow-up of patients with ST-elevation myocardial infarction (STEMI), treated with primary PCI.

we analysed 3114 consecutive STEMI patients. Patients presenting with cardiogenic schock were excluded. Echocardiographic examination was performed before hospital discharge and left ventricular ejection fraction (EF) was calculated using bi-plane method. The follow-up period was 6 years.

During 6-year follow-up, lethal outcome was registered in a total of 297 (9.5%) patients, of whom 95 (31.9%) had SCD. The highest incidence of SCD was recorded in the first year of follow-up, when SCD was registered in 25 patients, which is 26.3% of the total number of patients who had had SCD, i.e., 0.8% of the patients analyzed (Figure 1). The independent predictors for the occurrence of SCD during 6-year follow-up were EF<45% (HR 3.07, 95% 1.87-5.02), post-procedural TIMI flow <3 (HR 2.59, 95%CI 1.37-5.14), reduced baseline kidney function (HR 1.87, 95%CI 1.12-2.93) and Killip class >1 at admission (HR 1.69, 95%CI 1.23-2.97).

There is a low incidence of SCD in unselected STEMI patients treated with primary PCI. The independent predictors of SCD during long-term follow-up, in the patients analyzed, are: EF ≤ 45%, post-procedural flow TIMI < 3, Killip class > 1, and reduced baseline kidney function.