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Association of diabetes and kidney function according to age and systolic function with the incidence of sudden cardiac death and non‐sudden cardiac death in myocardial infarction survivors with heart failure
Author(s) -
Coiro Stefano,
Girerd Nicolas,
Sharma Abhinav,
Rossignol Patrick,
Tritto Isabella,
Pitt Bertram,
Pfeffer Marc A.,
McMurray John J.V.,
Ambrosio Giuseppe,
Dickstein Kenneth,
Moss Arthur,
Zannad Faiez
Publication year - 2019
Publication title -
european journal of heart failure
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.149
H-Index - 133
eISSN - 1879-0844
pISSN - 1388-9842
DOI - 10.1002/ejhf.1541
Subject(s) - medicine , ejection fraction , cardiology , hazard ratio , sudden cardiac death , heart failure , myocardial infarction , diabetes mellitus , renal function , cardiac function curve , confidence interval , endocrinology
Aims An implantable cardioverter‐defibrillator (ICD) is recommended for reducing the risk of sudden cardiac death (SCD) in myocardial infarction (MI) patients with a left ventricular ejection fraction (LVEF) ≤ 30%, as well as patients with a LVEF ≤ 35% and heart failure symptoms. Diabetes and/or impaired kidney function may confer additional SCD risk. We assessed the association between these two risk factors with SCD and non‐SCD among MI survivors taking account of age and LVEF. Methods and results A total of 17 773 patients from the High‐Risk MI Database were evaluated. Overall, diabetes and estimated glomerular filtration rate < 60 mL/min/1.73 m 2 , individually and together, conferred a higher risk of SCD [adjusted competing risk: hazard ratio (HR) 1.23, 1.23, and 1.32, respectively; all P < 0.03] and non‐SCD (HR 1.34, 1.52, and 2.13, respectively; all P < 0.0001). Annual SCD rates in patients with LVEF > 35% and with diabetes, impaired kidney function, or both (2.0%, 2.5% and 2.7%, respectively) were comparable to rates observed in patients with LVEF 30–35% but no such risk factors (1.7%). However, these patients had also similarly higher non‐SCD rates, such that the ratio of SCD to non‐SCD was not increased. Importantly, this ratio was mostly dependent on age, with higher overall ratios in youngest subgroups (0.89 in patients < 55 years vs. 0.38 in patients ≥ 75 years), regardless of risk factors. Conclusion Although MI survivors with LVEF > 35% with diabetes, impaired kidney function, or both are at increased risk of SCD, the risk of non‐SCD risk is even higher, suggesting an extension of the current indication for an ICD to them is unlikely to be worthwhile. MI survivors with low LVEF and aged < 55 years are likely to have the greatest potential benefit from ICD implantation.