Sudden death in patients evaluated for ischemic heart disease

Data from 981 patients evaluated for ischemic heart disease with coronary angiography were reviewed to identify variables predictive of sudden death and duration from onset of symptoms to death. During the period of follow-up, 113 patients died. Of these deaths, 99 were classified as cardiovascular. Forty percent occurred within 1 hour of onset of symptoms, 34% within 24 hours, and 25% in greater than 24 hours. Patients prone to sudden death were characterized as having severe multiple-vessel disease in combination with left ventricular dysfunction and disturbances in intraventricular conduction and rhythm. The best five-variable model to predict sudden death in these patients included the following variables: number of vessels greater than or equal to 70% obstructed (P less than .001); therapeutic requirement of inotropic (P less than .003) and diuretic (P less than .006) drugs; premature beats (P less than .006); and ventricular conduction defects (P less than .008). Additional variables were related significantly to the duration of the terminal episode. These data are preliminary, but indicate the possibility of identifying patients prone to sudden death.