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Sudden Death in CHD Patients Without Severe Systolic Dysfunction
Study Questions:
What is the risk of sudden and/or arrhythmic death (SAD) in patients with coronary heart disease (CHD) who have a left ventricular ejection fraction (LVEF) >35%?
Methods:
The subjects of this prospective, multicenter cohort study were 5,761 patients (mean age 64 years, mean LVEF 52%) with CHD and an LVEF >35% or class I heart failure (HF) and an LVEF >30%. The primary endpoint was SAD.
Results:
The cumulative incidence of SAD at a median follow-up of 3.9 months was 2.1% (annual incidence, 0.53%), compared to a 7.7% incidence of deaths not attributable to SAD. There was an inverse relationship between LVEF and risk of SAD. The incidence of SAD was highest in patients with an LVEF 30-40% (4.9%) and in patients with class III/IV HF (5.1%), and was lowest (1.0%) in the subgroup with an LVEF >60%. The proportion of deaths due to SAD was highest (49%) among patients <60 years and lowest (14%) in patients with class II HF.
Conclusions:
In patients with CHD without severe LV dysfunction, SAD accounts for approximately 20% of all deaths. Depending on LVEF, age, and HF class, the incidence of SAD is as high as approximately 5%/year.
Perspective:
The low overall risk of SAD in the present study lends support for the threshold levels of LV dysfunction used to identify candidates for an implantable cardioverter-defibrillator (ICD) for primary prevention of SAD. However, the study points out the importance of further risk stratification among the “low-risk” patients with CHD. The risk of SAD can be as high as 5.1%/year in these patients, which approaches the degree of risk at which ICD implantation is considered to be cost-effective.
Keywords: Arrhythmias, Cardiac, Coronary Disease, Death, Sudden, Death, Sudden, Cardiac, Defibrillators, Implantable, Heart Failure, Heart Failure, Systolic, Primary Prevention, Risk, Stroke Volume, Systole, Ventricular Function, Left
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