American Journal of Cardiology
Volume 104, Issue 2 , Pages 158-163, 15 July 2009

Sudden Cardiac Death in Patients With Silent Myocardial Ischemia After Myocardial Infarction (from the Swiss Interventional Study on Silent Ischemia Type II [SWISSI II])

  • Andreas Wolfgang Schoenenberger, MD

      Affiliations

    • Department of Geriatrics and Department of General Internal Medicine, University of Bern Hospital Inselspital Bern, Switzerland
    • Institute of Social and Preventive Medicine, University of Berne, Switzerland
    • ,
  • Richard Kobza, MD

      Affiliations

    • Department of Cardiology, Luzerner Kantonsspital, Lucerne, Switzerland
    • ,
  • Peiman Jamshidi, MD

      Affiliations

    • Department of Cardiology, Luzerner Kantonsspital, Lucerne, Switzerland
    • ,
  • Michel Zuber, MD

      Affiliations

    • Department of Cardiology, Luzerner Kantonsspital, Lucerne, Switzerland
    • ,
  • Antonio Abbate, MD

      Affiliations

    • Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia
    • ,
  • Andreas Ernst Stuck, MD

      Affiliations

    • Department of Geriatrics and Department of General Internal Medicine, University of Bern Hospital Inselspital Bern, Switzerland
    • Institute of Social and Preventive Medicine, University of Berne, Switzerland
    • ,
  • Matthias Pfisterer, MD

      Affiliations

    • Department of Cardiology, University Hospital, Basel, Switzerland
    • ,
  • Paul Erne, MD

      Affiliations

    • Department of Cardiology, Luzerner Kantonsspital, Lucerne, Switzerland
    • Corresponding Author InformationCorresponding author: Tel: +41-41-2055208; fax: +41-41-2055109

Received 12 January 2009; received in revised form 8 March 2009; accepted 8 March 2009. published online 18 May 2009.

The occurrence of sudden cardiac death (SCD) in patients with silent ischemia after myocardial infarction (MI) and the factors facilitating SCD are unknown. This study aimed to determine the factors facilitating SCD in patients with silent ischemia after MI. In the Swiss Interventional Study on Silent Ischemia Type II (SWISSI II), 201 patients with silent ischemia after MI were randomized to percutaneous coronary intervention (PCI) or medical management. The main end point of the present analysis was SCD. Multivariable regression models were used to detect potential associations between baseline or follow-up variables and SCD. During a mean follow-up of 10.3 ± 2.6 years, 12 SCDs occurred, corresponding to an average annual event rate of 0.6%. On multivariate regression analysis, the decline in the left ventricular ejection fraction (LVEF) during follow-up was the only independent predictor of SCD (p = 0.011), other than age; however, the baseline LVEF was not. The decline in LVEF was greater in patients receiving medical management than in those who had received PCI (p <0.001), as well as in patients with residual myocardial ischemia or recurrent MI compared with patients without these findings (p = 0.038 and p <0.001, respectively). Compared with medical management, PCI reduced the rate of residual myocardial ischemia (p <0.001) and recurrent MI (p = 0.001) during follow-up. In conclusion, patients with silent ischemia after MI are at a substantial risk of SCD. The prevention of residual myocardial ischemia and recurrent MI using PCI resulted in better long-term LVEF and a reduced SCD incidence.

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 The Swiss Interventional Study on Silent Ischemia Type II was funded by a grant from the von Muralt Stiftung/Swiss Heart Foundation, Berne, Switzerland, and supported by unrestricted grants from Hoechst Pharma, Merck Pharma, and Pfizer, all in Switzerland. Andreas Schoenenberger, MD, was supported by a Forschungskolleg Geriatrie Grant from the Robert Bosch Foundation, Stuttgart, Germany. None of the granting institutions had any influence on the study design, data collection, analysis and interpretation. All authors have disclosed all associations (either commercial or industrial) that might pose a conflict of interest.

PII: S0002-9149(09)00723-1

doi:10.1016/j.amjcard.2009.03.019

American Journal of Cardiology
Volume 104, Issue 2 , Pages 158-163, 15 July 2009

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