We must identify patients at risk for pre-hospital sudden cardiac arrest at the early phase of myocardial infarction

Global coronary heart disease mortality has markedly decreased for the last 4 decades thanks to primary prevention. More than half of the total reduction has been achieved by controlling cardiovascular risk factors (1). Concurrently, effective therapeutic modalities have contributed to reducing further in-hospital fatal events, obtaining a 6–8% reduction (1,2). Meanwhile, out-of-hospital sudden cardiac arrest (SCA) secondary to myocardial infarction remains high, and still represents the majority of all fatal cardiac events (3). Although there is a large amount of literature regarding this sudden and unexpected complication, there is still need for a better understanding of associated risk factors and to identify patients at highest risk for SCA at the pre-hospital phase. Early recognition of the risk of this grim complication could permit a better triage of high-risk patients and consequently improve their outcome.