The Clinical Challenge of Predicting and Preventing Sudden Cardiac Death Immediately after Myocardial Infarction

Abstract

Despite many advances in treatment of myocardial infarction (MI) with percutaneous coronary intervention (PCI) and pharmacologic therapies, mortality immediately after MI remains high in patients with impaired left ventricular function. One of the greatest challenges facing the contemporary cardiologist is predicting and preventing sudden cardiac death (SCD) immediately after MI. Unfortunately, the trials assessing the role of the implantable cardioverter defibrillator (ICD) in patients at high risk for SCD immediately post MI have failed to show survival benefit. Current clinical guidelines restrict ICD implants to patients at least 40 days after MI with continued left ventricular dysfunction while on optimal medical therapy. It is evident that additional research is needed to identify strategies to prevent SCD and improve survival immediately after MI. In the meantime, clinicians should optimize and individualize therapy in the immediate post MI patient while carefully considering the risk of SCD and the competing risk of mortality from other causes.