TY - JOUR
T1 - Sudden cardiac death after myocardial infarction
T2 - individual participant data from pooled cohorts
AU - Peek, Niels
AU - Hindricks, Gerhard
AU - Akbarov, Artur
AU - Tijssen, Jan G.P.
AU - Jenkins, David A.
AU - Kapacee, Zoher
AU - Parkes, Le Mai
AU - van der Geest, Rob J.
AU - Longato, Enrico
AU - Sprague, Daniel
AU - Taleb, Youssef
AU - Ong, Marcus
AU - Miller, Christopher A.
AU - Shamloo, Alireza Sepehri
AU - Albert, Christine
AU - Barthel, Petra
AU - Boveda, Serge
AU - Braunschweig, Frieder
AU - Johansen, Jens Brock
AU - Cook, Nancy
AU - de Chillou, Christian
AU - Elders, Petra
AU - Faxén, Jonas
AU - Friede, Tim
AU - Fusini, Laura
AU - Gale, Chris P.
AU - Jarkovsky, Jiri
AU - Jouven, Xavier
AU - Junttila, Juhani
AU - Kautzner, Josef
AU - Kiviniemi, Antti
AU - Kutyifa, Valentina
AU - Leclercq, Christophe
AU - Lee, Daniel C.
AU - Leigh, Jill
AU - Lenarczyk, Radosław
AU - Leyva, Francisco
AU - Maeng, Michael
AU - Manca, Andrea
AU - Marijon, Eloi
AU - Marschall, Ursula
AU - Merino, Jose Luis
AU - Mont, Lluis
AU - Nielsen, Jens Cosedis
AU - Olsen, Thomas
AU - Pester, Julie
AU - Pontone, Gianluca
AU - Roca, Ivo
AU - Schmidt, Georg
AU - Olesen, Kevin Kris Warnakula
AU - PROFID consortium
N1 - Publisher Copyright:
© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.
PY - 2024/11/14
Y1 - 2024/11/14
N2 - Background and Risk stratification of sudden cardiac death after myocardial infarction and prevention by defibrillator rely on left ventricular Aims ejection fraction (LVEF). Improved risk stratification across the whole LVEF range is required for decision-making on defibrillator implantation. Methods 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. Results 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. Conclusions 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.
AB - Background and Risk stratification of sudden cardiac death after myocardial infarction and prevention by defibrillator rely on left ventricular Aims ejection fraction (LVEF). Improved risk stratification across the whole LVEF range is required for decision-making on defibrillator implantation. Methods 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. Results 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. Conclusions 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.
KW - Implantable cardioverter-defibrillator
KW - Myocardial infarction
KW - Primary prevention
KW - Sudden cardiac death
UR - http://www.scopus.com/inward/record.url?scp=85209260955&partnerID=8YFLogxK
U2 - 10.1093/eurheartj/ehae326
DO - 10.1093/eurheartj/ehae326
M3 - Journal article
C2 - 39378245
SN - 0195-668X
VL - 45
SP - 4616
EP - 4626
JO - European Heart Journal
JF - European Heart Journal
IS - 43
ER -