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[Sudden cardiac death and arrhythmia profile in patients with single-vessel coronary disease]
H J Trappe1, C A Hartwig, H Klein
1Abteilung Kardiologie, Medizinische Hochschule Hannover.
Insights
Sudden cardiac death risk is low in single vessel disease. However, left anterior descending artery occlusion or right coronary artery lesions combined with complex arrhythmias and akinetic left ventricular areas independently predict sudden death.
Area of Science:
- Cardiology
- Cardiac Electrophysiology
- Interventional Cardiology
Context:
- Single vessel disease affects a significant patient population.
- Assessing risk factors for sudden cardiac death (SCD) is crucial.
- Coronary artery lesions, ventricular function, and arrhythmias are potential SCD predictors.
Purpose:
- To investigate the incidence of sudden death in patients with single vessel disease.
- To identify predictors of sudden death in this cohort.
- To correlate coronary artery lesions, left ventricular wall motion, and arrhythmias with SCD.
Summary:
- A study followed 214 patients with single vessel disease for an average of 51 months.
- Sudden death incidence was 11.1% in LAD, 7.3% in RCA, and 6.7% in LCX lesions.
- Coronary artery occlusion, akinetic left ventricular areas, and complex arrhythmias were independent predictors of sudden death, particularly with LAD or RCA involvement.
Impact:
- Identifies high-risk patient subgroups within single vessel disease.
- Informs clinical risk stratification and management strategies.
- Highlights the importance of comprehensive assessment including arrhythmias and ventricular function.
Abstract:
214 patients with single vessel disease (high grade stenosis greater than or equal to 75% or occlusion of the LAD, RCA or LCX) were followed for 1-78 months, average 51 months. Incidence of sudden death was studied in relation to coronary artery lesions, left ventricular wall motion and ventricular arrhythmias found during ambulatory ECG monitoring at the time of angiography. Incidence of sudden death was 11.1% (16/144) in LAD, 7.3% (4/55) in RCA and 6.7% (1/15) in LCX lesions. Coronary artery occlusion was associated with a significantly higher incidence of sudden death (14.6%, 18/123) than high-grade stenosis (3.3%, 3/91) (p less than 0.05). The risk of sudden death increased markedly in patients with complex arrhythmias and an occluded LAD or RCA (21.0%, 8/38; 18.2%, 2/11) compared to patients without complex arrhythmias (14.7%, 5/34; 5.5%, 1/18) (p = ns). Only one patient (1/15, 6.7%) with an isolated LCX lesion died suddenly. Our data show that the incidence of sudden death over 51 months is relatively low in patients with single vessel disease. However, LAD occlusion or RCA lesion with akinetic left ventricular areas and complex arrhythmias are independent predictors of sudden death.