Incidence and Predictors of Out-of-Hospital Cardiac Arrest Within 90 Days After Myocardial Infarction

J Am Coll Cardiol. 2020 Dec 22;76(25):2926-2936. doi: 10.1016/j.jacc.2020.10.033.


Background: The risk of sudden cardiac death (SCD) is high early after myocardial infarction (MI). Current knowledge and guidelines mainly rely on results from older clinical trials and registry studies. Left ventricular ejection fraction (LVEF) alone has not been proven a reliable predictor of SCD.

Objectives: This study sought to identify the incidence and additional predictors of SCD early after MI in a contemporary nationwide setting.

Methods: The authors used data from SWEDEHEART, the Swedish Cardiopulmonary Resuscitation Registry, and the Swedish Pacemaker and Implantable Cardioverter-Defibrillator (ICD) Registry. Cases of MI, which had undergone coronary angiography and were discharged alive between 2009 to 2017 without a prior ICD, were followed up to 90 days. Cox regression models were used to assess associations between clinical parameters and out-of-hospital cardiac arrest (OHCA).

Results: Among 121,379 cases, OHCA occurred in 349 (0.29%) and non-OHCA death in 2,194 (1.8%). A total of 6 variables (male sex, diabetes, estimated glomerular filtration rate <30 ml/min/1.73 m2, Killip class ≥II, new-onset atrial fibrillation/flutter, and impaired LVEF [reference ≥50%] categorized as 40% to 49%, 30% to 39%, and <30%) were identified as independent predictors, were assigned points, and were grouped into 3 categories, where the incidence of OHCA ranged from 0.12% to 2.0% and non-OHCA death from 0.76% to 11.7%. Stratified by LVEF <40% alone, the incidence of OHCA was 0.20% and 0.76% and for non-OHCA death 1.1% and 4.9%.

Conclusions: In this nationwide study, the incidence of OHCA within 90 days after MI was <0.3%. A total of 5 clinical parameters in addition to LVEF predicted OHCA and non-OHCA death better than LVEF alone.

Keywords: cardiac arrest; epidemiology; myocardial infarction; predictors; sudden cardiac death.

MeSH terms

  • Aged
  • Atrial Fibrillation* / diagnosis
  • Atrial Fibrillation* / epidemiology
  • Atrial Fibrillation* / etiology
  • Coronary Angiography / methods
  • Coronary Angiography / statistics & numerical data
  • Diabetes Mellitus* / diagnosis
  • Diabetes Mellitus* / epidemiology
  • Female
  • Glomerular Filtration Rate*
  • Humans
  • Incidence
  • Male
  • Myocardial Infarction* / complications
  • Myocardial Infarction* / therapy
  • Out-of-Hospital Cardiac Arrest* / diagnosis
  • Out-of-Hospital Cardiac Arrest* / epidemiology
  • Patient Discharge / statistics & numerical data
  • Prognosis
  • Registries / statistics & numerical data
  • Risk Assessment / methods
  • Risk Factors
  • Sex Factors
  • Stroke Volume*
  • Sweden / epidemiology
  • Ventricular Dysfunction, Left* / diagnosis
  • Ventricular Dysfunction, Left* / epidemiology
  • Ventricular Dysfunction, Left* / etiology