In contrast to individuals with a poor ejection fraction after an acute coronary syndrome (ACS), little was known about cardiovascular events’ long-term occurrence and impact preceding sudden death among stable patients following an ACS. In the IMPROVE-IT (Improved Reduction of Outcomes: Vytorin Efficacy International Trial), a total of 18,144 patients stabilized within 10 days following ACS. Researchers determined cumulative incidence rates (IRs) and IRs per 100 patient-years of sudden death. The link of more than or equal to 1 extra post-randomization cardiovascular event (myocardial infarction, stroke, and hospitalization for unstable angina or heart failure) with sudden death was investigated using Cox proportional hazards. Early (less than or equal to a year after ACS) and late (more than a year) unexpected deaths were compared. About 402 (16%) of the 2,446 fatalities were unexpected. With 109 early and 293 late sudden fatalities, the median time to premature death was 2.7 years. At 7 years of follow-up, the cumulative IR was 2.47% (95% CI, 2.23% –2.73%). The risk of sudden death after a post-randomization cardiovascular event (150/402 [37%] sudden deaths; median 1.4 years) was higher (IR/100 patient-years, 1.45 [95% CI, 1.23–1.69]) than the risk of sudden death without a post-randomization cardiovascular event (IR/100 patient-years, 0.27 [95% CI, 0.24–0.30]). Myocardial infarction (HR, 3.64 [95% CI, 2.85–4.66]) and heart failure (HR, 4.55 [95% CI, 3.33–6.22]) after randomization significantly elevated the risk of sudden death in the future. Patients who stabilized within ten days of an ACS were nonetheless at risk of sudden death in the long run, with those who have had another cardiovascular incident being at the highest risk. The outcomes defined the long-term risk and risk effectors of sudden death, perhaps assisting doctors in identifying areas where care should have been improved.

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