Predictors of sudden death up to 18 years after a first attack of unstable angina or myocardial infarction

Abstract

Factors related to the occurrence of sudden death were examined in 551 men aged <60 years who survived a first attack of unstable angina or myocardial infarction by at least 28 days. There were 301 deaths over an average follow up period of 9.4 years and 138 (46%) of these were sudden. Life table techniques permitted the estimation of mortality up to 18 years after the index event. The proportion of sudden deaths showed a decrease with length of follow up. In those who were non-smokers and in those aged <45 years on admission sudden deaths in the first two years were very uncommon (80% (95% confidence interval: 69%-91%) and 79% (95% confidence interval: 68%-90%) respectively). The proportion of sudden deaths in the remaining 16 years of follow up was related inversely to age at initial attack. After the first two years of follow up sudden death rates were similar in those who continued to smoke and those who stopped smoking, although those who continued to smoke had a significantly higher overall mortality. The risk of sudden death should be borne in mind when planning the investigation and rehabilitation of young and non-smoking subjects presenting with a first coronary event.