Sudden cardiac death in stable coronary artery disease: A literature review

Sudden cardiac death (SCD) remains a leading cause of mortality in patients with stable coronary artery disease (CAD), despite advances in diagnosis, risk stratification, and therapy. This review synthesises current evidence on epidemiology, pathophysiology, clinical predictors, and preventive strategies for SCD in chronic coronary syndromes. Historical perspectives, including early autopsy observations, highlight the longstanding recognition of SCD as a complication of CAD. Contemporary data reveal that SCD often represents the first clinical manifestation of coronary heart disease, with a substantial proportion of cases occurring in individuals classified as low risk. Mechanistically, SCD is frequently triggered by acute ischemia or arrhythmogenic substrates in the context of structural and electrical remodeling. Key predictors include left ventricular dysfunction, ventricular arrhythmias, and specific electrocardiographic markers, though their predictive value in stable CAD remains limited. Preventive strategies range from optimal medical therapy and lifestyle interventions to device-based approaches, such as implantable cardioverter-defibrillators, in selected high-risk subgroups. Despite these measures, risk stratification tools lack sufficient sensitivity and specificity to guide widespread prophylactic interventions. Future research should focus on refining predictive models by integrating clinical, imaging, and biomarker data to enable more targeted prevention of SCD in stable CAD populations.