Sudden cardiac death in patients with stable coronary artery disease and preserved left ventricular systolic function
Judith Hsia1, Kathleen A Jablonski, Madeline Murguia Rice
1Department of Medicine, George Washington University, Washington, DC, USA. judith.hsia@astrazeneca.com
Insights
Predicting sudden cardiac death (SCD) in coronary artery disease (CAD) patients with preserved ejection fraction is possible. Simple clinical factors can identify individuals at higher risk for SCD, guiding preventative strategies.
Area of Science:
- Cardiology
- Clinical Trials
- Predictive Analytics
Background:
- Sudden cardiac death (SCD) prediction is challenging in coronary artery disease (CAD) patients with preserved left ventricular ejection fraction.
- Existing research primarily focuses on SCD in patients with reduced ejection fraction.
Purpose of the Study:
- To identify baseline predictors of SCD in stable CAD patients with preserved left ventricular systolic function.
- To develop a risk scoring algorithm for SCD in this specific patient population.
Main Methods:
- Randomized 8,290 stable CAD patients with preserved ejection fraction to trandolapril or placebo.
- Utilized Cox proportional hazards models for a median 4.8-year follow-up to identify SCD predictors.
- Developed a risk scoring algorithm based on clinical characteristics.
Main Results:
- Independent SCD predictors included age, current angina, ejection fraction between 40-50%, and diuretic/digitalis use.
- Negative predictors of SCD were prior coronary revascularization, female sex, and Caucasian ethnicity.
- Trandolapril did not significantly alter SCD rates.
Conclusions:
- Clinical characteristics effectively identify higher-risk individuals for SCD among stable CAD patients with preserved ejection fraction.
- A risk scoring algorithm can aid in stratifying SCD risk in this population.
- These findings support targeted preventative strategies in CAD patients with preserved ejection fraction.
Abstract:
Although sudden cardiac death (SCD) has been extensively studied in patients with coronary artery disease (CAD) and low ejection fraction, prediction of SCD among individuals with preserved left ventricular systolic function is less well understood. We randomized 8,290 patients with stable CAD with preserved left ventricular systolic function to trandolapril or placebo in a secondary coronary prevention trial, and we used Cox proportional hazards models to identify independent baseline predictors of SCD during 4.8 year follow-up (median). Using a risk scoring algorithm based on simple clinical characteristics, we were able to distinguish individuals at higher risk for SCD. Independent determinants of SCD included age (p <0.001), current angina pectoris (p = 0.002), ejection fraction >40% to <50% (as opposed to >50%) (p <0.001), and diuretic (p <0.001) and digitalis use (p <0.001). Negative predictors included having prior coronary revascularization (p = 0.01) and being female (p = 0.02) or Caucasian (p = 0.006). Trandolapril neither increased nor decreased SCD. Thus, among patients with stable CAD with preserved left ventricular systolic function receiving current standard-of-care including coronary revascularization, clinical characteristics can identify individuals at higher risk for SCD.
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