Abstract
Sudden cardiac death (SCD) is one of the most common causes of death in the world. Coronary heart disease (CHD) is the root cause of most patients with SCD, and myocardial infarction (MI) is the main cause of SCD among all types of CHD. Early identification of high-risk patients after an MI, and the application of related prevention strategies and disease-specific treatments will be the key to reduce SCD. The mechanism of SCD after MI varies over time, and the relevant risk prediction indicators are also dynamic and different. In the existing guidelines for MI patients, the static and slightly single stratification of primary (PP) and secondary (SP) prevention has significant room for improvement. The 1.5 primary prevention (1.5PP) is defined as patients with PP who also had the following risk factors: non-sustained ventricular tachycardia (NSVT), frequent premature ventricular contractions (PVCs), severe heart failure (left ventricular ejection fraction, LVEF <25%), and syncope or pre-syncope. The emergence of 1.5PP has provided a new method for the stratification and management of SCD after an MI.
Highlights
Sudden cardiac death (SCD) is defined by the American Heart Association (AHA) as a natural death caused by the heart that occurs within 1 hour after the onset of acute symptoms and is characterized by a sudden loss of consciousness [1]
In the Defibrillator in Acute Myocardial Infarction Trials (DINAMIT) and Immediate Risk Stratification Improves Survival (IRIS) trials [17, 18], it was found that premature implantation of ICDs failed to improve the survival rate in early PP after an myocardial infarction (MI)
The three major milestone randomized trials for SP include the Antiarrhythmics vs. Implantable Defibrillator (AVID) trial, the Hamburg Cardiac Arrest Study (CASH), and the Canadian Implantable Defibrillator Study (CIDS) [19,20,21]. These studies have shown that ICDs can improve the survival of patients with fatal ventricular tachyarrhythmias (VTA) and reduce the incidence of death and that the efficacy is significantly better than anti-arrhythmic drugs in patients with resuscitated ventricular fibrillation (VF) arrest, syncope with persistent ventricular tachycardia (VT), left ventricular ejection fraction (LVEF) ≤40%; patients with persistent VT; patients with resuscitated cardiac arrest and persistent ventricular arrhythmia; patients who were evaluated after resuscitated VT/VF cessation, and those with persistent VT and syncope, persistent VT, and symptoms due to persistent depressed ventricular function
Summary
Sudden cardiac death (SCD) is defined by the American Heart Association (AHA) as a natural death caused by the heart that occurs within 1 hour after the onset of acute symptoms and is characterized by a sudden loss of consciousness [1]. MI is the leading cause of SCD among all types of CHD and the risk of SCD among MI patients is 4–6 times higher than that of the general population [7, 8]. The early prevention and management of high-risk patients after an MI is important to effectively reduce the incidence of SCD. The risk of SCD after an MI is a dynamic process that is highly dependent on the incidence of myocardial death, changes in heart rhythm, and changes with time after an MI [9]. The main mechanisms of SCD after an MI will be reviewed and their corresponding prediction indicators, and the related therapeutic interventions will be discussed according to the risk stratification method of 1.5PP
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