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Journal ArticleDOI

Sudden Death in Patients with Myocardial Infarction and Left Ventricular Dysfunction, Heart Failure, or Both

TLDR
The risk of sudden death is highest in the first 30 days after myocardial infarction among patients with left ventricular dysfunction, heart failure, or both, and earlier implementation of strategies for preventing sudden death may be warranted in selected patients.
Abstract
Background The risk of sudden death from cardiac causes is increased among survivors of acute myocardial infarction with reduced left ventricular systolic function. We assessed the risk and time course of sudden death in high-risk patients after myocardial infarction. Methods We studied 14,609 patients with left ventricular dysfunction, heart failure, or both after myocardial infarction to assess the incidence and timing of sudden unexpected death or cardiac arrest with resuscitation in relation to the left ventricular ejection fraction. Results Of 14,609 patients, 1067 (7 percent) had an event a median of 180 days after myocardial infarction: 903 died suddenly, and 164 were resuscitated after cardiac arrest. The risk was highest in the first 30 days after myocardial infarction — 1.4 percent per month (95 percent confidence interval, 1.2 to 1.6 percent) — and decreased to 0.14 percent per month (95 percent confidence interval, 0.11 to 0.18 percent) after 2 years. Patients with a left ventricular ejection ...

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Early intravenous then oral metoprolol in 45 852 patients with acute myocardial infarction: randomised placebo- controlled trial

TL;DR: The use of early beta-blocker therapy in acute MI reduces the risks of reinfarction and ventricular fibrillation, but increases the risk of cardiogenic shock, especially during the first day or so after admission.
References
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Journal ArticleDOI

Prophylactic implantation of a defibrillator in patients with myocardial infarction and reduced ejection fraction.

TL;DR: In patients with a prior myocardial infarction and advanced left ventricular dysfunction, prophylactic implantation of a defibrillator improves survival and should be considered as a recommended therapy.
Journal ArticleDOI

Decreased heart rate variability and its association with increased mortality after acute myocardial infarction

TL;DR: HR variability remained a significant predictor of mortality after adjusting for clinical, demographic, other Holter features and ejection fraction, and a hypothesis to explain this finding is that decreased HR variability correlates with increased sympathetic or decreased vagal tone, which may predispose to ventricular fibrillation.
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