Sudden cardiac death after myocardial infarction: individual participant data from pooled cohorts

Niels Peek; Gerhard Hindricks; Artur Akbarov; Jan G P Tijssen; David A Jenkins; Zoher Kapacee; Le Mai Parkes; Rob J van der Geest; Enrico Longato; Daniel Sprague; Youssef Taleb; Marcus Ong; Christopher A Miller; Alireza Sepehri Shamloo; Christine Albert; Petra Barthel; Serge Boveda; Frieder Braunschweig; Jens Brock Johansen; Nancy Cook; Christian de Chillou; Petra Elders; Jonas Faxén; Tim Friede; Laura Fusini; Chris P Gale; Jiri Jarkovsky; Xavier Jouven; Juhani Junttila; Josef Kautzner; Antti Kiviniemi; Valentina Kutyifa; Christophe Leclercq; Daniel C Lee; Jill Leigh; Radosław Lenarczyk; Francisco Leyva-Leon; Michael Maeng; Andrea Manca; Eloi Marijon; Ursula Marschall; Jose Luis Merino; Lluis Mont; Jens Cosedis Nielsen; Thomas Olsen; Julie Pester; Gianluca Pontone; Ivo Roca; Georg Schmidt; Peter J Schwartz; Christian Sticherling; Mahmoud Suleiman; Milos Taborsky; Hanno L Tan; Jacob Tfelt-Hansen; Holger Thiele; Gordon F Tomaselli; Tom Verstraelen; Manickavasagar Vinayagamoorthy; Kevin Kris Warnakula Olesen; Arthur Wilde; Rik Willems; Katherine C Wu; Markus Zabel; Glen P Martin; Nikolaos Dagres

doi:10.1093/eurheartj/ehae326

Sudden cardiac death after myocardial infarction: individual participant data from pooled cohorts

Niels Peek
, Gerhard Hindricks
, Artur Akbarov
, Jan G P Tijssen
, David A Jenkins
, Zoher Kapacee
, Le Mai Parkes
, Rob J van der Geest
, Enrico Longato
, Daniel Sprague
, Youssef Taleb
, Marcus Ong
, Christopher A Miller
, Alireza Sepehri Shamloo
, Christine Albert
, Petra Barthel
, Serge Boveda
, Frieder Braunschweig
, Jens Brock Johansen
, Nancy Cook

Christian de Chillou, Petra Elders, Jonas Faxén, Tim Friede, Laura Fusini, Chris P Gale, Jiri Jarkovsky, Xavier Jouven, Juhani Junttila, Josef Kautzner, Antti Kiviniemi, Valentina Kutyifa, Christophe Leclercq, Daniel C Lee, Jill Leigh, Radosław Lenarczyk, Francisco Leyva-Leon, Michael Maeng, Andrea Manca, Eloi Marijon, Ursula Marschall, Jose Luis Merino, Lluis Mont, Jens Cosedis Nielsen, Thomas Olsen, Julie Pester, Gianluca Pontone, Ivo Roca, Georg Schmidt, Peter J Schwartz, Christian Sticherling, Mahmoud Suleiman, Milos Taborsky, Hanno L Tan, Jacob Tfelt-Hansen, Holger Thiele, Gordon F Tomaselli, Tom Verstraelen, Manickavasagar Vinayagamoorthy, Kevin Kris Warnakula Olesen, Arthur Wilde, Rik Willems, Katherine C Wu, Markus Zabel, Glen P Martin, Nikolaos Dagres

Clinical Epidemiology and Biostatistics, The AMC, Amsterdam, The Netherlands.
University of Manchester
Department of Medicine; Solna, Karolinska Institutet and ME Cardiology, Karolinska University Hospital , Norrbacka S1:02, Eugeniavagen 27, Stockholm 171 77 , Sweden
Beth Israel Deaconess Medical Center
Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.
Leeds Institute of Cardiovascular and Metabolic Medicine University of Leeds Leeds UK
Centre for Health Economics, University of York, York, UK.
Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
Cardiology, University Hospitals Leuven, Leuven, Belgium.
Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.

Research output: Contribution to journal › Article › peer-review

46 Citations (SciVal)

66 Downloads (Pure)

Abstract

BACKGROUND AND AIMS: Risk stratification of sudden cardiac death after myocardial infarction and prevention by defibrillator rely on left ventricular ejection fraction (LVEF). Improved risk stratification across the whole LVEF range is required for decision-making on defibrillator implantation. METHODS: The analysis pooled 20 data sets with 140 204 post-myocardial infarction patients containing information on demographics, medical history, clinical characteristics, biomarkers, electrocardiography, echocardiography, and cardiac magnetic resonance imaging. Separate analyses were performed in patients (i) carrying a primary prevention cardioverter-defibrillator with LVEF ≤ 35% [implantable cardioverter-defibrillator (ICD) patients], (ii) without cardioverter-defibrillator with LVEF ≤ 35% (non-ICD patients ≤ 35%), and (iii) without cardioverter-defibrillator with LVEF > 35% (non-ICD patients >35%). Primary outcome was sudden cardiac death or, in defibrillator carriers, appropriate defibrillator therapy. Using a competing risk framework and systematic internal-external cross-validation, a model using LVEF only, a multivariable flexible parametric survival model, and a multivariable random forest survival model were developed and externally validated. Predictive performance was assessed by random effect meta-analysis. RESULTS: There were 1326 primary outcomes in 7543 ICD patients, 1193 in 25 058 non-ICD patients ≤35%, and 1567 in 107 603 non-ICD patients >35% during mean follow-up of 30.0, 46.5, and 57.6 months, respectively. In these three subgroups, LVEF poorly predicted sudden cardiac death (c-statistics between 0.50 and 0.56). Considering additional parameters did not improve calibration and discrimination, and model generalizability was poor. CONCLUSIONS: More accurate risk stratification for sudden cardiac death and identification of low-risk individuals with severely reduced LVEF or of high-risk individuals with preserved LVEF was not feasible, neither using LVEF nor using other predictors.

Original language	English
Pages (from-to)	4616-4626
Number of pages	11
Journal	European Heart Journal
Volume	45
Issue number	43
Early online date	8 Oct 2024
DOIs	https://doi.org/10.1093/eurheartj/ehae326
Publication status	Published - 14 Nov 2024

Bibliographical note

Copyright © The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.

Funding

This project has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No. 847999.

Keywords

Myocardial infarction
Primary prevention
Implantable cardioverter-defibrillator
Sudden cardiac death

Access to Document

10.1093/eurheartj/ehae326Licence: CC BY 4.0

PROFID consortium_Sudden cardiac death after MI_individual participant data from pooled cohorts
Copyright © The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
Final published version, 1.45 MBLicence: CC BY 4.0

Cite this

Peek, N., Hindricks, G., Akbarov, A., Tijssen, J. G. P., Jenkins, D. A., Kapacee, Z., Parkes, L. M., van der Geest, R. J., Longato, E., Sprague, D., Taleb, Y., Ong, M., Miller, C. A., Shamloo, A. S., Albert, C., Barthel, P., Boveda, S., Braunschweig, F., Johansen, J. B., ... Dagres, N. (2024). Sudden cardiac death after myocardial infarction: individual participant data from pooled cohorts. European Heart Journal, 45(43), 4616-4626. https://doi.org/10.1093/eurheartj/ehae326

@article{a03352ad56e64091b2a784c18eba9f61,

title = "Sudden cardiac death after myocardial infarction: individual participant data from pooled cohorts",

abstract = "BACKGROUND AND AIMS: Risk stratification of sudden cardiac death after myocardial infarction and prevention by defibrillator rely on left ventricular ejection fraction (LVEF). Improved risk stratification across the whole LVEF range is required for decision-making on defibrillator implantation. METHODS: The analysis pooled 20 data sets with 140 204 post-myocardial infarction patients containing information on demographics, medical history, clinical characteristics, biomarkers, electrocardiography, echocardiography, and cardiac magnetic resonance imaging. Separate analyses were performed in patients (i) carrying a primary prevention cardioverter-defibrillator with LVEF ≤ 35\% [implantable cardioverter-defibrillator (ICD) patients], (ii) without cardioverter-defibrillator with LVEF ≤ 35\% (non-ICD patients ≤ 35\%), and (iii) without cardioverter-defibrillator with LVEF > 35\% (non-ICD patients >35\%). Primary outcome was sudden cardiac death or, in defibrillator carriers, appropriate defibrillator therapy. Using a competing risk framework and systematic internal-external cross-validation, a model using LVEF only, a multivariable flexible parametric survival model, and a multivariable random forest survival model were developed and externally validated. Predictive performance was assessed by random effect meta-analysis. RESULTS: There were 1326 primary outcomes in 7543 ICD patients, 1193 in 25 058 non-ICD patients ≤35\%, and 1567 in 107 603 non-ICD patients >35\% during mean follow-up of 30.0, 46.5, and 57.6 months, respectively. In these three subgroups, LVEF poorly predicted sudden cardiac death (c-statistics between 0.50 and 0.56). Considering additional parameters did not improve calibration and discrimination, and model generalizability was poor. CONCLUSIONS: More accurate risk stratification for sudden cardiac death and identification of low-risk individuals with severely reduced LVEF or of high-risk individuals with preserved LVEF was not feasible, neither using LVEF nor using other predictors.",

keywords = "Myocardial infarction, Primary prevention, Implantable cardioverter-defibrillator, Sudden cardiac death",

author = "Niels Peek and Gerhard Hindricks and Artur Akbarov and Tijssen, \{Jan G P\} and Jenkins, \{David A\} and Zoher Kapacee and Parkes, \{Le Mai\} and \{van der Geest\}, \{Rob J\} and Enrico Longato and Daniel Sprague and Youssef Taleb and Marcus Ong and Miller, \{Christopher A\} and Shamloo, \{Alireza Sepehri\} and Christine Albert and Petra Barthel and Serge Boveda and Frieder Braunschweig and Johansen, \{Jens Brock\} and Nancy Cook and \{de Chillou\}, Christian and Petra Elders and Jonas Fax{\'e}n and Tim Friede and Laura Fusini and Gale, \{Chris P\} and Jiri Jarkovsky and Xavier Jouven and Juhani Junttila and Josef Kautzner and Antti Kiviniemi and Valentina Kutyifa and Christophe Leclercq and Lee, \{Daniel C\} and Jill Leigh and Rados{\l}aw Lenarczyk and Francisco Leyva-Leon and Michael Maeng and Andrea Manca and Eloi Marijon and Ursula Marschall and Merino, \{Jose Luis\} and Lluis Mont and Nielsen, \{Jens Cosedis\} and Thomas Olsen and Julie Pester and Gianluca Pontone and Ivo Roca and Georg Schmidt and Schwartz, \{Peter J\} and Christian Sticherling and Mahmoud Suleiman and Milos Taborsky and Tan, \{Hanno L\} and Jacob Tfelt-Hansen and Holger Thiele and Tomaselli, \{Gordon F\} and Tom Verstraelen and Manickavasagar Vinayagamoorthy and Olesen, \{Kevin Kris Warnakula\} and Arthur Wilde and Rik Willems and Wu, \{Katherine C\} and Markus Zabel and Martin, \{Glen P\} and Nikolaos Dagres",

note = "Copyright {\textcopyright} The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.",

year = "2024",

month = nov,

day = "14",

doi = "10.1093/eurheartj/ehae326",

language = "English",

volume = "45",

pages = "4616--4626",

journal = "European Heart Journal",

issn = "0195-668X",

publisher = "Oxford University Press",

number = "43",

}

Peek, N, Hindricks, G, Akbarov, A, Tijssen, JGP, Jenkins, DA, Kapacee, Z, Parkes, LM, van der Geest, RJ, Longato, E, Sprague, D, Taleb, Y, Ong, M, Miller, CA, Shamloo, AS, Albert, C, Barthel, P, Boveda, S, Braunschweig, F, Johansen, JB, Cook, N, de Chillou, C, Elders, P, Faxén, J, Friede, T, Fusini, L, Gale, CP, Jarkovsky, J, Jouven, X, Junttila, J, Kautzner, J, Kiviniemi, A, Kutyifa, V, Leclercq, C, Lee, DC, Leigh, J, Lenarczyk, R, Leyva-Leon, F, Maeng, M, Manca, A, Marijon, E, Marschall, U, Merino, JL, Mont, L, Nielsen, JC, Olsen, T, Pester, J, Pontone, G, Roca, I, Schmidt, G, Schwartz, PJ, Sticherling, C, Suleiman, M, Taborsky, M, Tan, HL, Tfelt-Hansen, J, Thiele, H, Tomaselli, GF, Verstraelen, T, Vinayagamoorthy, M, Olesen, KKW, Wilde, A, Willems, R, Wu, KC, Zabel, M, Martin, GP & Dagres, N 2024, 'Sudden cardiac death after myocardial infarction: individual participant data from pooled cohorts', European Heart Journal, vol. 45, no. 43, pp. 4616-4626. https://doi.org/10.1093/eurheartj/ehae326

TY - JOUR

T1 - Sudden cardiac death after myocardial infarction: individual participant data from pooled cohorts

AU - Peek, Niels

AU - Hindricks, Gerhard

AU - Akbarov, Artur

AU - Tijssen, Jan G P

AU - Jenkins, David A

AU - Kapacee, Zoher

AU - Parkes, Le Mai

AU - van der Geest, Rob J

AU - Longato, Enrico

AU - Sprague, Daniel

AU - Taleb, Youssef

AU - Ong, Marcus

AU - Miller, Christopher A

AU - Shamloo, Alireza Sepehri

AU - Albert, Christine

AU - Barthel, Petra

AU - Boveda, Serge

AU - Braunschweig, Frieder

AU - Johansen, Jens Brock

AU - Cook, Nancy

AU - de Chillou, Christian

AU - Elders, Petra

AU - Faxén, Jonas

AU - Friede, Tim

AU - Fusini, Laura

AU - Gale, Chris P

AU - Jarkovsky, Jiri

AU - Jouven, Xavier

AU - Junttila, Juhani

AU - Kautzner, Josef

AU - Kiviniemi, Antti

AU - Kutyifa, Valentina

AU - Leclercq, Christophe

AU - Lee, Daniel C

AU - Leigh, Jill

AU - Lenarczyk, Radosław

AU - Leyva-Leon, Francisco

AU - Maeng, Michael

AU - Manca, Andrea

AU - Marijon, Eloi

AU - Marschall, Ursula

AU - Merino, Jose Luis

AU - Mont, Lluis

AU - Nielsen, Jens Cosedis

AU - Olsen, Thomas

AU - Pester, Julie

AU - Pontone, Gianluca

AU - Roca, Ivo

AU - Schmidt, Georg

AU - Schwartz, Peter J

AU - Sticherling, Christian

AU - Suleiman, Mahmoud

AU - Taborsky, Milos

AU - Tan, Hanno L

AU - Tfelt-Hansen, Jacob

AU - Thiele, Holger

AU - Tomaselli, Gordon F

AU - Verstraelen, Tom

AU - Vinayagamoorthy, Manickavasagar

AU - Olesen, Kevin Kris Warnakula

AU - Wilde, Arthur

AU - Willems, Rik

AU - Wu, Katherine C

AU - Zabel, Markus

AU - Martin, Glen P

AU - Dagres, Nikolaos

N1 - Copyright © The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.

PY - 2024/11/14

Y1 - 2024/11/14

N2 - BACKGROUND AND AIMS: Risk stratification of sudden cardiac death after myocardial infarction and prevention by defibrillator rely on left ventricular ejection fraction (LVEF). Improved risk stratification across the whole LVEF range is required for decision-making on defibrillator implantation. METHODS: The analysis pooled 20 data sets with 140 204 post-myocardial infarction patients containing information on demographics, medical history, clinical characteristics, biomarkers, electrocardiography, echocardiography, and cardiac magnetic resonance imaging. Separate analyses were performed in patients (i) carrying a primary prevention cardioverter-defibrillator with LVEF ≤ 35% [implantable cardioverter-defibrillator (ICD) patients], (ii) without cardioverter-defibrillator with LVEF ≤ 35% (non-ICD patients ≤ 35%), and (iii) without cardioverter-defibrillator with LVEF > 35% (non-ICD patients >35%). Primary outcome was sudden cardiac death or, in defibrillator carriers, appropriate defibrillator therapy. Using a competing risk framework and systematic internal-external cross-validation, a model using LVEF only, a multivariable flexible parametric survival model, and a multivariable random forest survival model were developed and externally validated. Predictive performance was assessed by random effect meta-analysis. RESULTS: There were 1326 primary outcomes in 7543 ICD patients, 1193 in 25 058 non-ICD patients ≤35%, and 1567 in 107 603 non-ICD patients >35% during mean follow-up of 30.0, 46.5, and 57.6 months, respectively. In these three subgroups, LVEF poorly predicted sudden cardiac death (c-statistics between 0.50 and 0.56). Considering additional parameters did not improve calibration and discrimination, and model generalizability was poor. CONCLUSIONS: More accurate risk stratification for sudden cardiac death and identification of low-risk individuals with severely reduced LVEF or of high-risk individuals with preserved LVEF was not feasible, neither using LVEF nor using other predictors.

AB - BACKGROUND AND AIMS: Risk stratification of sudden cardiac death after myocardial infarction and prevention by defibrillator rely on left ventricular ejection fraction (LVEF). Improved risk stratification across the whole LVEF range is required for decision-making on defibrillator implantation. METHODS: The analysis pooled 20 data sets with 140 204 post-myocardial infarction patients containing information on demographics, medical history, clinical characteristics, biomarkers, electrocardiography, echocardiography, and cardiac magnetic resonance imaging. Separate analyses were performed in patients (i) carrying a primary prevention cardioverter-defibrillator with LVEF ≤ 35% [implantable cardioverter-defibrillator (ICD) patients], (ii) without cardioverter-defibrillator with LVEF ≤ 35% (non-ICD patients ≤ 35%), and (iii) without cardioverter-defibrillator with LVEF > 35% (non-ICD patients >35%). Primary outcome was sudden cardiac death or, in defibrillator carriers, appropriate defibrillator therapy. Using a competing risk framework and systematic internal-external cross-validation, a model using LVEF only, a multivariable flexible parametric survival model, and a multivariable random forest survival model were developed and externally validated. Predictive performance was assessed by random effect meta-analysis. RESULTS: There were 1326 primary outcomes in 7543 ICD patients, 1193 in 25 058 non-ICD patients ≤35%, and 1567 in 107 603 non-ICD patients >35% during mean follow-up of 30.0, 46.5, and 57.6 months, respectively. In these three subgroups, LVEF poorly predicted sudden cardiac death (c-statistics between 0.50 and 0.56). Considering additional parameters did not improve calibration and discrimination, and model generalizability was poor. CONCLUSIONS: More accurate risk stratification for sudden cardiac death and identification of low-risk individuals with severely reduced LVEF or of high-risk individuals with preserved LVEF was not feasible, neither using LVEF nor using other predictors.

KW - Myocardial infarction

KW - Primary prevention

KW - Implantable cardioverter-defibrillator

KW - Sudden cardiac death

UR - https://academic.oup.com/eurheartj/advance-article/doi/10.1093/eurheartj/ehae326/7815795

UR - https://www.scopus.com/pages/publications/85209260955

U2 - 10.1093/eurheartj/ehae326

DO - 10.1093/eurheartj/ehae326

M3 - Article

C2 - 39378245

SN - 0195-668X

VL - 45

SP - 4616

EP - 4626

JO - European Heart Journal

JF - European Heart Journal

IS - 43

ER -

Sudden cardiac death after myocardial infarction: individual participant data from pooled cohorts

Abstract

Bibliographical note

Funding

Keywords

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