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Sudden Death in Patients With Coronary Heart Disease Without Severe Systolic Dysfunction
Journal article   Open access   Peer reviewed

Sudden Death in Patients With Coronary Heart Disease Without Severe Systolic Dysfunction

Neal A. Chatterjee, M. Vinayaga Moorthy, Julie Pester, Andi Schaecter, Gopi K. Panicker, Dhiraj Narula, Daniel C. Lee, Jeffrey J. Goldberger, Alan Kadish, Nancy R. Cook, …
JAMA cardiology, v 3(7), pp 591-600
01 Jul 2018
DOI: https://doi.org/10.1001/jamacardio.2018.1049
PMID: 29801082
Featured in Collection :   UN Sustainable Development Goals @ Drexel
url
https://doi.org/10.1001/jamacardio.2018.1049View
Published, Version of Record (VoR)Maybe Open Access (Publisher Bronze),  Open

Abstract

Cardiac & Cardiovascular Systems Cardiovascular System & Cardiology Life Sciences & Biomedicine Science & Technology
IMPORTANCE The majority of sudden and/or arrhythmic deaths (SAD) in patients with coronary heart disease occur in those without severe systolic dysfunction, for whom strategies for sudden death prevention are lacking. OBJECTIVE To provide contemporary estimates of SAD vs other competing causes of death in patients with coronary heart disease without severe systolic dysfunction to search for high-risk subgroups that might be targeted in future trials of SAD prevention. DESIGN, SETTING, AND PARTICIPANTS This prospective observational cohort study included 135 clinical sites in the United States and Canada. A total of 5761participants with coronary heart disease who did not qualify for primary prevention implantable cardioverter defibrillator therapy based on left ventricular ejection fraction (LVEF) of more than 35% or New York Heart Association (NYHA) heart failure class (LVEF >30%. NYHA l). EXPOSURES Clinical risk factors measured at baseline including age, LVEF, and NYHA heart failure class. MAIN OUTCOMES AND MEASURES Primary outcome of SAD, which is a composite of SAD and resuscitated ventricular fibrillation arrest. RESULTS The mean (SD) age of the cohort was 64 (11) years. During a median of 3.9 years, the cumulative incidence of SAD and non-SAD was 2.1% and 7.7%, respectively. Sudden and/or arrhythmic death was the most common mode of cardiovascular death accounting for 114 of 202 cardiac deaths (56%), although noncardiac death was the primary mode of death in this population. The 4-year cumulative incidence of SAD was lowest in those with an LVEF of more than 60% (1.0%) and highest among those with LVEF of 30% to 40% (4.9%) and class III/IV heart failure (5.1%); however, the cumulative incidence of non-SAD was similarly elevated in these latter high-risk subgroups. Patients with a moderately reduced LVEF (40%-49%) were more likely to die of SAD, whereas those with class II heart failure and advancing age were more likely to die of non-SAD. The proportion of deaths due to SAD varied widely, from 14% (18 of 131deaths) in patients with NYHA II to 49% (37 of 76 deaths) in those younger than 60 years. CONCLUSIONS AND RELEVANCE In a contemporary population of patients with coronary heart disease without severe systolic dysfunction, SAD accounts for a significant proportion of overall mortality. Moderately reduced LVEF, age, and NYHA class distinguished SAD and non-SAD, whereas other markers were equally associated with both modes of death. Absolute and proportional risk of SAD varied significantly across clinical subgroups, and both will need to be maximized in future risk stratification efforts.

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48 citations in Web of Science
52 citations in Scopus

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#3 Good Health and Well-Being

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Web of Science research areas
Cardiac & Cardiovascular Systems
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