Syncope and risk of sudden cardiac arrest in coronary artery disease
Aapo L Aro1, Carmen Rusinaru2, Audrey Uy-Evanado2
1Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland.
Insights
Syncope, or fainting, is linked to a higher risk of sudden cardiac arrest (SCA) in coronary artery disease (CAD) patients. This risk persists even with normal left ventricular function, highlighting syncope as a key indicator.
Area of Science:
- Cardiology
- Public Health
- Epidemiology
Background:
- Syncope is a known risk factor for sudden cardiac arrest (SCA) in specific heart conditions.
- However, the association between syncope and SCA risk in patients with coronary artery disease (CAD), a leading cause of SCA, remains understudied.
Purpose of the Study:
- To investigate the association between syncope and the risk of sudden cardiac arrest (SCA) in patients with coronary artery disease (CAD).
- To determine if syncope is an independent risk factor for SCA in CAD patients, including those with preserved left ventricular function.
Main Methods:
- A prospective study identified all SCA cases due to CAD in Portland, Oregon, from 2002-2015.
- Cases were compared to geographical controls, with detailed clinical data, including syncope history, extracted from medical records.
Main Results:
- The analysis included 2119 SCA cases and 746 controls.
- A history of syncope was documented in 6.8% of SCA cases.
- After adjusting for clinical factors and left ventricular ejection fraction (LVEF), syncope was associated with a 2.8-fold increased risk of SCA (OR 2.8; 95%CI 1.68-4.85).
- This elevated risk remained significant (adjusted OR 3.1; 95%CI 1.68-5.79) even in patients with LVEF ≥50%.
Conclusions:
- Syncope is associated with an increased risk of SCA in patients with coronary artery disease (CAD).
- This association holds true even in patients with preserved left ventricular function.
- Syncope may serve as a valuable clinical marker for SCA risk stratification in a large subgroup of CAD patients with normal LVEF.
Background:
Syncope has been associated with increased risk of sudden cardiac arrest (SCA) in specific patient populations, such as hypertrophic cardiomyopathy, heart failure, and long QT syndrome, but data are lacking on the risk of SCA associated with syncope among patients with coronary artery disease (CAD), the most common cause of SCA. We investigated this association among CAD patients in the community.
Methods:
All cases of SCA due to CAD were prospectively identified in Portland, Oregon (population approximately 1 million) as part of the Oregon Sudden Unexpected Death Study 2002-2015, and compared to geographical controls. Detailed clinical information including history of syncope and cardiac investigations was obtained from medical records.
Results:
2119 SCA cases (68.4±13.8years, 66.9% male) and 746 controls (66.7±11.7years, 67.0% male) were included in the analysis. 143 (6.8%) of cases had documented syncope prior to the SCA. SCA cases with syncope were >5years older and had more comorbidities than other SCA cases. After adjusting for clinical factors and left ventricular ejection fraction (LVEF), syncope was associated with increased risk of SCA (OR 2.8; 95%CI 1.68-4.85). When analysis was restricted to subjects with LVEF ≥50%, the risk of SCA associated with syncope remained significantly elevated (adjusted OR 3.1; 95%CI 1.68-5.79).
Conclusions:
Syncope was associated with increased risk of SCA in CAD patients even with preserved LV function. These findings suggest a role for this clinical marker among patients with CAD and normal LVEF, a large sub-group without any current means of SCA risk stratification.
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