Cardiac Death in the first 6 months after myocardial infarction: potential for mortality reduction in the early posthospital period.

In a prospective postmyocardial infarction study of 759 patients aged less than 66 years, 42 posthospital cardiac deaths (42 of 759; 6 percent) occurred during a 6 month follow-up period. The average age of those who died was 53.5 +/- 8.8 (+/- standard error) years, and postmortem examination was obtainedon 36 percent. Almost 60 percent of the 6 month posthospital mortality occurred within 2 months after hospital discharge. Fifty-five percent of the cardiac deaths occurred either outside th ehospital or within hospital emergency departments, and 62 percent of the deaths were sudden (within 12 hours) or unwitnessed. The suspected mechanism of cardiac death was a primary arrhythmia in 62 percent, and a definite or probable myocardial infarction was diagnosed in only 41 percent. Use of digitalis and diuretic and antiarrhythmic agents was significantly (P is less than 0.025) greater in this group during the week before death than in a comparison survivor group; no difference in use of propranolol or tranquilizers was noted between the two groups. Fifty percent of the group that died had two or more of the following factors: death outside the hospital, sudden death, primary arrhythmic death. These findings indicate that a considerable potential exists for reducing cardiac death in the early posthospital phase of myocardial infarction.