Predictors of sudden cardiac death change with time after myocardial infarction: results from the VALIANT trial

Aims: To determine whether predictors of sudden cardiac death (SCD) vary with time after myocardial infarction (MI). Methods and results: We analysed 11 256 patients enrolled in VALIANT. Landmark analysis and Cox proportional hazards modelling were used to predict SCD during hospitalization, from discharge to 30 days, 30 days to 6 months, and 6 months to 3 years. The cumulative incidence of SCD was 8.6% (n = 965). Initially, higher baseline heart rate [HR 1.20 per 10 b.p.m. (95% CI 1.06–1.37)] and impaired baseline creatinine clearance [HR 0.82 per 10 mL/min (95% CI 0.74–0.91)] were stronger predictors of SCD. With long-term follow-up, prior MI [HR 1.71 (95% CI 1.39–2.10)], initial left ventricular ejection fraction <40% [HR 0.67 per 10% (95% CI 0.58–0.78)], and recurrent cardiovascular events [HR 1.47 for rehospitalization (95% CI 1.17–1.86)] were more robust risk stratifiers for SCD. Atrial fibrillation post-MI was associated with an increased risk of SCD over the entire follow-up period. As time passed, the associations between baseline clinical characteristics and SCD decreased and time-updated assessments became more important. Conclusion: Predictors of SCD change with time after MI. Future studies of risk stratification for SCD should account for changes in these factors with time after MI