The chronology and suddenness of cardiac death after myocardial infarction.

A prospective postinfarction study of 978 patients less tha 66 years of age followed from 1 to 5 years was utilized to evaluate the chronology (interval from hospital discharge to demise) and suddenness (elapsed time from the onset of terminal symptoms to demise) of cardiac death. Clinical information including the patient's history and CCU, 6-hour Holter electrocardiographic, medication, and mortality event data was available on 112 cardiac deaths, with 56% of those with witness deaths dying suddenly (less than or equal to 1 hour). During the first postinfarction year 50% of the nonsudden deaths occurred within the first month after hospital discharge, whereas 84% of the sudden deaths occurred in the 2 to 12 month period after infarction (Chi Square = 6.25, p less than 0.02). There were no clinical variables including Holter-recorded ventricular premature beats that distinguished between early and late or sudden and nonsudden cardiac death. These findings indicate that the chronology and suddenness of the terminal cardiac event are more difficult to predict than had previously been appreciated. The therapeutic implications of these observations are discussed.