Sudden Death in Patients with Myocardial Infarction
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《新英格兰医药杂志》
To the Editor: Solomon and colleagues (June 23 issue)1 report that in the Valsartan in Acute Myocardial Infarction Trial (VALIANT), 19 percent of patients with heart failure, left ventricular dysfunction, or both, after myocardial infarction who died suddenly from cardiac causes or had cardiac arrest with resuscitation did so within the first 30 days after infarction. In the Eplerenone Post–Acute Myocardial Infarction Heart Failure Efficacy and Survival Study (EPHESUS),2 involving patients with both heart failure and left ventricular dysfunction (an ejection fraction of 40 percent) after myocardial infarction, my colleagues and I recently found that there was a similar high, early incidence of sudden death from cardiac causes and that eplerenone reduced this risk by 37 percent (P=0.051) within 30 days after randomization.3 In patients with an ejection fraction of 30 percent or less after myocardial infarction, who Solomon et al. pointed out had an even higher risk of early sudden death from cardiac causes, we have recently found a 58 percent reduction in sudden death from cardiac causes within 30 days among patients randomly assigned to receive eplerenone (P=0.008).4 We believe that these findings are of special importance in view of the failure of implantable cardioverter–defibrillators to reduce the risk of early sudden death from cardiac causes after myocardial infarction in a similar group of patients.5
Bertram Pitt, M.D.
University of Michigan Medical Center
Ann Arbor, MI 48109
bpitt@med.umich.edu
for the EPHESUS Investigators
Dr. Pitt reports having served as a consultant to Pfizer, which sponsored EPHESUS.
References
Solomon SD, Zelenkofske S, McMurray JJV, et al. Sudden death in patients with myocardial infarction and left ventricular dysfunction, heart failure, or both. N Engl J Med 2005;353:2581-2588.
Pitt B, Remme W, Zannad F, et al. Eplerenone, a selective aldosterone blocker, in patients with left ventricular dysfunction after myocardial infarction. N Engl J Med 2003;348:1309-1321.
Pitt B, White H, Nicolau J, et al. Eplerenone reduces mortality 30 days after randomization following acute myocardial infarction in patients with left ventricular systolic dysfunction and heart failure. J Am Coll Cardiol 2005;46:425-431.
Bertram Pitt, M.D.
University of Michigan Medical Center
Ann Arbor, MI 48109
bpitt@med.umich.edu
for the EPHESUS Investigators
Dr. Pitt reports having served as a consultant to Pfizer, which sponsored EPHESUS.
References
Solomon SD, Zelenkofske S, McMurray JJV, et al. Sudden death in patients with myocardial infarction and left ventricular dysfunction, heart failure, or both. N Engl J Med 2005;353:2581-2588.
Pitt B, Remme W, Zannad F, et al. Eplerenone, a selective aldosterone blocker, in patients with left ventricular dysfunction after myocardial infarction. N Engl J Med 2003;348:1309-1321.
Pitt B, White H, Nicolau J, et al. Eplerenone reduces mortality 30 days after randomization following acute myocardial infarction in patients with left ventricular systolic dysfunction and heart failure. J Am Coll Cardiol 2005;46:425-431.