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Short- and long-term risk factors for sudden death in patients with stable angina
D Benchimol1, B Dubroca, V Bernard
1Service de Cardiologie et Maladies Vasculaires, Hôpital Cardiologique, 33604, Pessac, France.
Insights
Sudden cardiac death risk factors in stable angina differ over time. Peripheral arterial disease and LDL cholesterol predict short-term risk, while obesity and fibrinogen predict long-term risk. Ejection fraction is a consistent predictor.
Area of Science:
- Cardiology
- Preventive Medicine
- Clinical Research
Background:
- Sudden cardiac death (SCD) is a primary manifestation of coronary heart disease (CHD), yet its prediction remains challenging.
- Risk factors for SCD in stable angina patients with proven coronary artery disease are not well-defined, especially concerning time-dependent variations.
Purpose of the Study:
- To identify and assess short-term and long-term risk factors for sudden death in patients with stable angina and angiographically confirmed coronary artery disease.
Main Methods:
- Prospective study of 319 consecutive patients with stable angina, excluding those with heart failure or recent myocardial infarction.
- Clinical, angiographic, and biological data were collected, and associations with sudden death risk were analyzed using univariate and multivariate logistic regression.
Main Results:
- Twenty-five sudden deaths occurred over a mean follow-up of 97 months.
- Short-term (2-year) independent predictors included peripheral arterial disease (PAD), ejection fraction (EF), and low-density lipoprotein (LDL) cholesterol.
- Long-term (8-10 year) independent predictors were body mass index (BMI), EF, and fibrinogen. PAD was the strongest short-term predictor, while BMI and fibrinogen were key long-term predictors. EF was the only time-independent predictor.
Conclusions:
- Risk factors for sudden death in stable angina are time-dependent.
- PAD and LDL cholesterol are critical for short-term risk stratification, whereas BMI and fibrinogen are important for long-term risk assessment.
- Ejection fraction serves as a consistent, time-independent predictor of sudden death in this patient cohort.
Abstract:
Sudden death is most common and often the first manifestation of coronary heart disease although its risk is difficult to predict. It has been studied mainly in patients with severe ventricular arrhythmia or recent myocardial infarction, but little is known about the different risk factors for short- and long-term risk of sudden death in patients with stable angina. To assess risk factors for sudden death in patients with stable angina and angiographically proven coronary artery disease, 319 consecutive patients were recruited prospectively and followed-up. Patients with clinical heart failure or recent myocardial infarction were excluded. Clinical, angiographic and biological variables were recorded. The association between each variable and the risk of sudden death was assessed in univariate and logistic multivariate analysis. There were 25 sudden deaths during the follow-up period (97+/-29 months). The univariate predictors in the short-term (2 years) were: peripheral arterial disease, left ventricular hypertrophy, low density lipoprotein cholesterol and ejection fraction. The independent predictors were: peripheral arterial disease (relative risk: 6.3), ejection fraction (relative risk 1.05) and low density lipoprotein (relative risk: 1.8). In the long-term (8-10 years), body mass index, coronary score, ejection fraction and fibrinogen were univariate predictors. Only body mass index (relative risk: 1. 2), ejection fraction (relative risk: 1.06) and fibrinogen (relative risk: 2) remained independent predictors. The risk factors for sudden death in stable angina were time-dependent, peripheral arterial disease appeared as the best predictor with LDL for short time, and body mass index (obesity: index >27) and fibrinogen for long time. Ejection fraction was the only time-independent predictor.