Letter by McEvoy Regarding Article, “Pathogenesis of Sudden Unexpected Death in a Clinical Trial of Patients With Myocardial Infarction and Left Ventricular Dysfunction, Heart Failure, or Both”

To the Editor:In an effort to explore the negative results of implantable cardioverter-defibrillator (ICD) trials early after acute myocardial infarction (MI),1,2 Pouleur et al3 present the findings of a thought-provoking analysis from the VALsartan In Acute myocardial infarctioN Trial (VALIANT). Within this nonrandomized autopsy series of 398 patients, rates of recurrent MI/myocardial rupture were highest in the early post-MI period and declined with time among the 105 patients who were clinically adjudicated to have “circumstances of sudden unexpected death.” In contrast, the rates of presumed arrhythmic death increased in this group over time.3 The authors conclude that this may “explain …