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Extreme Risk of Sudden Cardiac Death within Three Months after Revascularization in Patients with Ischemic Left
Shaoping Wang1,2, Yi Lyu3, Yanci Liu1
1Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, 100029 Beijing, China.
Insights
Sudden cardiac death (SCD) risk is highest in the first 3 months post-revascularization for patients with left ventricular (LV) dysfunction. History of ventricular tachycardia/fibrillation and triple vessel disease predict early SCD risk.
Area of Science:
- Cardiology
- Cardiac Surgery
- Clinical Research
Background:
- Sudden cardiac death (SCD) risk in patients with left ventricular (LV) systolic dysfunction post-coronary revascularization requires further characterization.
- Understanding the incidence and temporal pattern of SCD is crucial for managing these high-risk patients.
Purpose of the Study:
- To evaluate the incidence and time course of SCD after coronary revascularization in patients with LV systolic dysfunction.
- To identify determinants of SCD within the initial 3 months following revascularization.
Main Methods:
- A cohort study involving 2317 patients with ejection fraction (EF) < 40% who underwent revascularization.
- Estimated SCD incidence accounting for competing risks of mortality.
- Assessed risk factors for SCD within 3 months post-revascularization.
Main Results:
- SCD accounted for 32.1% of deaths (162 out of 504) during a median follow-up of 3.5 years.
- The highest SCD risk occurred within the first 3 months post-revascularization (0.37%/month), decreasing thereafter.
- History of ventricular tachycardia/fibrillation (HR 5.55) and triple vessel disease (HR 3.90) were significant predictors of early SCD; preoperative EF was not predictive.
Conclusions:
- Patients with LV dysfunction face the highest risk of SCD in the first 3 months after revascularization.
- Further research is needed for improved risk stratification and tailored treatment strategies for this patient group.
Background:
The risk of sudden cardiac death (SCD) after coronary revascularization in patients with left ventricular (LV) systolic dysfunction has not been characterized completely. This study aims to evaluate the incidence and time course of SCD after revascularization in such patients. The determinants of SCD within 3 months after revascularization were also assessed.
Methods:
A cohort study of patients with reduced ejection fraction (EF 40%), who underwent revascularization was performed. The incidence of SCD was estimated to account for the competing risk of deaths due to other causes.
Results:
2317 patients were enrolled. With a median follow-up of 3.5 years, 162 (32.1%) of the 504 deaths were due to SCD. The risk of SCD was highest in the first 3 months after revascularization, with an incidence rate of 0.37%/month. The event rate decreased to 0.12%/month, 0.08%/month, 0.09%/month, 0.14%/month, and 0.19%/month at 3-6 months, 6-12 months, 1-3 years, 3-5 years, and 5-10 years, respectively. A history of ventricular tachycardia/ventricular fibrillation (hazard ratio [HR], 5.55; 95% confidence interval [CI], 1.33-23.19; p = 0.019) and triple vessel disease (HR, 3.90; 95% CI, 1.38-11.05; p = 0.010) were associated with the risk of SCD within 3 months. However, preoperative EF (in 5% increments) was not predictive (HR per 5% increase, 0.98; 95% CI, 0.62-1.55; p = 0.935).
Conclusions:
For patients with LV dysfunction, the risk of SCD was the highest during the first 3 months after revascularization. Further risk classification and treatment strategy are warranted.
Clinical Trial Registration:
The name of the registry: Coronary Revascularization in Patients with Ischemic Heart Failure and Prevention of Sudden Cardiac Death. Registration number: ChiCTR2100044378.
