Sudden death in patients with coronary heart disease without severe systolic dysfunction

Neal A. Chatterjee, M. Vinayaga Moorthy, Julie Pester, Andi Schaecter, Gopi K. Panicker, Dhiraj Narula, Daniel C. Lee, Jeffrey J. Goldberger, Alan Kadish, Nancy R. Cook, Christine M. Albert, Christine M. Elbert, Sharan Mahal, John Sobolski, Sorin Danciu, Christopher Dyke, Robert Phang, David Wolinsky, Robert Biederman, Brent McLaurin & 137 others Benjamin Trichon, David Serfas, Azhar Aslam, William Bugni, Aziz Hany, Leng Jiang, Henri Marais, Sam Durr, Joel Reinoehl, Susan Graham, Diego Sadler, Norman Erenrich, Robert Spencer, John E.A. Griffin, Chris Geohas, Charles B. Treasure, Talal Baki, David Huneycutt, Walid Saliba, J. Thomas Svinarich, William Whang, Preetham Jetty, Jeffrey Shanes, Joseph McGarvey, Shelley Hankins, Lindsey L. White, David DeLurgio, Harischandra Karunaratne, Enrique Flores, Eve Gillespie, John McKenzie, Cezar Staniloae, Alexander Altschuller, Claudio Schuger, Michael Radin, Gerald Pohost, Mark Myers, T. Jared Bunch, William Wickemeyer, Robert Mendelson, Ronald Berger, Terence Ross, Andrew Sumner, Lee Arcement, Bilal Malik, Ned Claxton, Kathryn Rohr, Robert Weiss, Raul Garcia-Rinaldi, John Kazmierski, David Rosenbaum, Ronald Blonder, Kodangudi Ramanathan, Geariod O'Neill, Kevin Cochran, Elizabeth Kaufman, Otto Costantini, Stephen Hustead, Zakir Sahul, James Bengston, Ellis Lader, Matthew Nora, Charles Gornick, Selcuk Adabag, Steven Tishler, Steven Klein, Gervasio Lamas, Mirza Baig, Michelle Ratliff, Sei Iwai, Glover Johnson, Thomas Oliver, Michael Langer, Joon Ahn, Kevin H. Silver, Scott E. Mattson, Jay Schmidt, P. Kasi Ramanathan, John Heitner, Arthur Riba, Udho Thadani, Shujahat Shah, David Sandler, David Bello, Edward Mostel, Rajul Patel, Patrick Simpson, Terrence Hack, Charles Shoultz, Romel Figueredo, Mahmoud Atieh, John Herre, Mohit Bhasin, Andre Gauri, Charles Gottlieb, Peter Hotvedt, Muqtada Chaudhry, Steven Greenberg, W. Kevin Tsai, Marcus Averbach, Benjamin Cheong, Suneet Mittal, James Baker, Frank McGrew, David Kraus, Hal Skopicki, Sung Lee, Frank Gredler, Jamal Islam, Syed M. Mohiuddin, Miguel Valderrabano, Nadim Nasir, Daniel Anderson, Mark Niebauer, Pedro Colon-Hernandez, Judith Mackall, Roopinder Sandhu, Peter Ott, Hemal Nayak, Stephanie Dunlap, Juan Aranda, Steven Hsu, Steven Owens, Vincent See, Daniel Menees, Greg Flaker, Samir Saba, Michael Fong, Mehmet Aktas, Terrence O'Brien, Victoria Bernstein, Pablo Saavedra, Matthew Koshy, Sean Whalen, Zayd Eldadah, David Haines, Kevin Marzo

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

IMPORTANCE The majority of sudden and/or arrhythmic deaths (SAD) in patients with coronary heart disease occur in those without severe systolic dysfunction, for whom strategies for sudden death prevention are lacking. OBJECTIVE To provide contemporary estimates of SAD vs other competing causes of death in patients with coronary heart disease without severe systolic dysfunction to search for high-risk subgroups that might be targeted in future trials of SAD prevention. DESIGN, SETTING, AND PARTICIPANTS This prospective observational cohort study included 135 clinical sites in the United States and Canada. A total of 5761 participants with coronary heart disease who did not qualify for primary prevention implantable cardioverter defibrillator therapy based on left ventricular ejection fraction (LVEF) of more than 35%or New York Heart Association (NYHA) heart failure class (LVEF >30%, NYHA I). EXPOSURES Clinical risk factors measured at baseline including age, LVEF, and NYHA heart failure class. MAIN OUTCOMES AND MEASURES Primary outcome of SAD, which is a composite of SAD and resuscitated ventricular fibrillation arrest. RESULTS The mean (SD) age of the cohort was 64 (11) years. During a median of 3.9 years, the cumulative incidence of SAD and non-SAD was 2.1%and 7.7%, respectively. Sudden and/or arrhythmic death was the most common mode of cardiovascular death accounting for 114 of 202 cardiac deaths (56%), although noncardiac death was the primary mode of death in this population. The 4-year cumulative incidence of SAD was lowest in those with an LVEF of more than 60%(1.0%) and highest among those with LVEF of 30% to 40% (4.9%) and class III/IV heart failure (5.1%); however, the cumulative incidence of non-SAD was similarly elevated in these latter high-risk subgroups. Patients with a moderately reduced LVEF (40%-49%) were more likely to die of SAD, whereas those with class II heart failure and advancing age were more likely to die of non-SAD. The proportion of deaths due to SAD varied widely, from 14%(18 of 131 deaths) in patients with NYHA II to 49%(37 of 76 deaths) in those younger than 60 years. CONCLUSIONS AND RELEVANCE In a contemporary population of patients with coronary heart disease without severe systolic dysfunction, SAD accounts for a significant proportion of overall mortality. Moderately reduced LVEF, age, and NYHA class distinguished SAD and non-SAD, whereas other markers were equally associated with both modes of death. Absolute and proportional risk of SAD varied significantly across clinical subgroups, and both will need to be maximized in future risk stratification efforts.

Original languageEnglish (US)
Pages (from-to)591-600
Number of pages10
JournalJAMA Cardiology
Volume3
Issue number7
DOIs
StatePublished - Jul 1 2018

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Sudden Death
Coronary Disease
Stroke Volume
Heart Failure
Incidence

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Chatterjee, N. A., Moorthy, M. V., Pester, J., Schaecter, A., Panicker, G. K., Narula, D., ... Marzo, K. (2018). Sudden death in patients with coronary heart disease without severe systolic dysfunction. JAMA Cardiology, 3(7), 591-600. https://doi.org/10.1001/jamacardio.2018.1049

Sudden death in patients with coronary heart disease without severe systolic dysfunction. / Chatterjee, Neal A.; Moorthy, M. Vinayaga; Pester, Julie; Schaecter, Andi; Panicker, Gopi K.; Narula, Dhiraj; Lee, Daniel C.; Goldberger, Jeffrey J.; Kadish, Alan; Cook, Nancy R.; Albert, Christine M.; Elbert, Christine M.; Mahal, Sharan; Sobolski, John; Danciu, Sorin; Dyke, Christopher; Phang, Robert; Wolinsky, David; Biederman, Robert; McLaurin, Brent; Trichon, Benjamin; Serfas, David; Aslam, Azhar; Bugni, William; Hany, Aziz; Jiang, Leng; Marais, Henri; Durr, Sam; Reinoehl, Joel; Graham, Susan; Sadler, Diego; Erenrich, Norman; Spencer, Robert; Griffin, John E.A.; Geohas, Chris; Treasure, Charles B.; Baki, Talal; Huneycutt, David; Saliba, Walid; Svinarich, J. Thomas; Whang, William; Jetty, Preetham; Shanes, Jeffrey; McGarvey, Joseph; Hankins, Shelley; White, Lindsey L.; DeLurgio, David; Karunaratne, Harischandra; Flores, Enrique; Gillespie, Eve; McKenzie, John; Staniloae, Cezar; Altschuller, Alexander; Schuger, Claudio; Radin, Michael; Pohost, Gerald; Myers, Mark; Bunch, T. Jared; Wickemeyer, William; Mendelson, Robert; Berger, Ronald; Ross, Terence; Sumner, Andrew; Arcement, Lee; Malik, Bilal; Claxton, Ned; Rohr, Kathryn; Weiss, Robert; Garcia-Rinaldi, Raul; Kazmierski, John; Rosenbaum, David; Blonder, Ronald; Ramanathan, Kodangudi; O'Neill, Geariod; Cochran, Kevin; Kaufman, Elizabeth; Costantini, Otto; Hustead, Stephen; Sahul, Zakir; Bengston, James; Lader, Ellis; Nora, Matthew; Gornick, Charles; Adabag, Selcuk; Tishler, Steven; Klein, Steven; Lamas, Gervasio; Baig, Mirza; Ratliff, Michelle; Iwai, Sei; Johnson, Glover; Oliver, Thomas; Langer, Michael; Ahn, Joon; Silver, Kevin H.; Mattson, Scott E.; Schmidt, Jay; Ramanathan, P. Kasi; Heitner, John; Riba, Arthur; Thadani, Udho; Shah, Shujahat; Sandler, David; Bello, David; Mostel, Edward; Patel, Rajul; Simpson, Patrick; Hack, Terrence; Shoultz, Charles; Figueredo, Romel; Atieh, Mahmoud; Herre, John; Bhasin, Mohit; Gauri, Andre; Gottlieb, Charles; Hotvedt, Peter; Chaudhry, Muqtada; Greenberg, Steven; Tsai, W. Kevin; Averbach, Marcus; Cheong, Benjamin; Mittal, Suneet; Baker, James; McGrew, Frank; Kraus, David; Skopicki, Hal; Lee, Sung; Gredler, Frank; Islam, Jamal; Mohiuddin, Syed M.; Valderrabano, Miguel; Nasir, Nadim; Anderson, Daniel; Niebauer, Mark; Colon-Hernandez, Pedro; Mackall, Judith; Sandhu, Roopinder; Ott, Peter; Nayak, Hemal; Dunlap, Stephanie; Aranda, Juan; Hsu, Steven; Owens, Steven; See, Vincent; Menees, Daniel; Flaker, Greg; Saba, Samir; Fong, Michael; Aktas, Mehmet; O'Brien, Terrence; Bernstein, Victoria; Saavedra, Pablo; Koshy, Matthew; Whalen, Sean; Eldadah, Zayd; Haines, David; Marzo, Kevin.

In: JAMA Cardiology, Vol. 3, No. 7, 01.07.2018, p. 591-600.

Research output: Contribution to journalArticle

Chatterjee, NA, Moorthy, MV, Pester, J, Schaecter, A, Panicker, GK, Narula, D, Lee, DC, Goldberger, JJ, Kadish, A, Cook, NR, Albert, CM, Elbert, CM, Mahal, S, Sobolski, J, Danciu, S, Dyke, C, Phang, R, Wolinsky, D, Biederman, R, McLaurin, B, Trichon, B, Serfas, D, Aslam, A, Bugni, W, Hany, A, Jiang, L, Marais, H, Durr, S, Reinoehl, J, Graham, S, Sadler, D, Erenrich, N, Spencer, R, Griffin, JEA, Geohas, C, Treasure, CB, Baki, T, Huneycutt, D, Saliba, W, Svinarich, JT, Whang, W, Jetty, P, Shanes, J, McGarvey, J, Hankins, S, White, LL, DeLurgio, D, Karunaratne, H, Flores, E, Gillespie, E, McKenzie, J, Staniloae, C, Altschuller, A, Schuger, C, Radin, M, Pohost, G, Myers, M, Bunch, TJ, Wickemeyer, W, Mendelson, R, Berger, R, Ross, T, Sumner, A, Arcement, L, Malik, B, Claxton, N, Rohr, K, Weiss, R, Garcia-Rinaldi, R, Kazmierski, J, Rosenbaum, D, Blonder, R, Ramanathan, K, O'Neill, G, Cochran, K, Kaufman, E, Costantini, O, Hustead, S, Sahul, Z, Bengston, J, Lader, E, Nora, M, Gornick, C, Adabag, S, Tishler, S, Klein, S, Lamas, G, Baig, M, Ratliff, M, Iwai, S, Johnson, G, Oliver, T, Langer, M, Ahn, J, Silver, KH, Mattson, SE, Schmidt, J, Ramanathan, PK, Heitner, J, Riba, A, Thadani, U, Shah, S, Sandler, D, Bello, D, Mostel, E, Patel, R, Simpson, P, Hack, T, Shoultz, C, Figueredo, R, Atieh, M, Herre, J, Bhasin, M, Gauri, A, Gottlieb, C, Hotvedt, P, Chaudhry, M, Greenberg, S, Tsai, WK, Averbach, M, Cheong, B, Mittal, S, Baker, J, McGrew, F, Kraus, D, Skopicki, H, Lee, S, Gredler, F, Islam, J, Mohiuddin, SM, Valderrabano, M, Nasir, N, Anderson, D, Niebauer, M, Colon-Hernandez, P, Mackall, J, Sandhu, R, Ott, P, Nayak, H, Dunlap, S, Aranda, J, Hsu, S, Owens, S, See, V, Menees, D, Flaker, G, Saba, S, Fong, M, Aktas, M, O'Brien, T, Bernstein, V, Saavedra, P, Koshy, M, Whalen, S, Eldadah, Z, Haines, D & Marzo, K 2018, 'Sudden death in patients with coronary heart disease without severe systolic dysfunction', JAMA Cardiology, vol. 3, no. 7, pp. 591-600. https://doi.org/10.1001/jamacardio.2018.1049
Chatterjee NA, Moorthy MV, Pester J, Schaecter A, Panicker GK, Narula D et al. Sudden death in patients with coronary heart disease without severe systolic dysfunction. JAMA Cardiology. 2018 Jul 1;3(7):591-600. https://doi.org/10.1001/jamacardio.2018.1049
Chatterjee, Neal A. ; Moorthy, M. Vinayaga ; Pester, Julie ; Schaecter, Andi ; Panicker, Gopi K. ; Narula, Dhiraj ; Lee, Daniel C. ; Goldberger, Jeffrey J. ; Kadish, Alan ; Cook, Nancy R. ; Albert, Christine M. ; Elbert, Christine M. ; Mahal, Sharan ; Sobolski, John ; Danciu, Sorin ; Dyke, Christopher ; Phang, Robert ; Wolinsky, David ; Biederman, Robert ; McLaurin, Brent ; Trichon, Benjamin ; Serfas, David ; Aslam, Azhar ; Bugni, William ; Hany, Aziz ; Jiang, Leng ; Marais, Henri ; Durr, Sam ; Reinoehl, Joel ; Graham, Susan ; Sadler, Diego ; Erenrich, Norman ; Spencer, Robert ; Griffin, John E.A. ; Geohas, Chris ; Treasure, Charles B. ; Baki, Talal ; Huneycutt, David ; Saliba, Walid ; Svinarich, J. Thomas ; Whang, William ; Jetty, Preetham ; Shanes, Jeffrey ; McGarvey, Joseph ; Hankins, Shelley ; White, Lindsey L. ; DeLurgio, David ; Karunaratne, Harischandra ; Flores, Enrique ; Gillespie, Eve ; McKenzie, John ; Staniloae, Cezar ; Altschuller, Alexander ; Schuger, Claudio ; Radin, Michael ; Pohost, Gerald ; Myers, Mark ; Bunch, T. Jared ; Wickemeyer, William ; Mendelson, Robert ; Berger, Ronald ; Ross, Terence ; Sumner, Andrew ; Arcement, Lee ; Malik, Bilal ; Claxton, Ned ; Rohr, Kathryn ; Weiss, Robert ; Garcia-Rinaldi, Raul ; Kazmierski, John ; Rosenbaum, David ; Blonder, Ronald ; Ramanathan, Kodangudi ; O'Neill, Geariod ; Cochran, Kevin ; Kaufman, Elizabeth ; Costantini, Otto ; Hustead, Stephen ; Sahul, Zakir ; Bengston, James ; Lader, Ellis ; Nora, Matthew ; Gornick, Charles ; Adabag, Selcuk ; Tishler, Steven ; Klein, Steven ; Lamas, Gervasio ; Baig, Mirza ; Ratliff, Michelle ; Iwai, Sei ; Johnson, Glover ; Oliver, Thomas ; Langer, Michael ; Ahn, Joon ; Silver, Kevin H. ; Mattson, Scott E. ; Schmidt, Jay ; Ramanathan, P. Kasi ; Heitner, John ; Riba, Arthur ; Thadani, Udho ; Shah, Shujahat ; Sandler, David ; Bello, David ; Mostel, Edward ; Patel, Rajul ; Simpson, Patrick ; Hack, Terrence ; Shoultz, Charles ; Figueredo, Romel ; Atieh, Mahmoud ; Herre, John ; Bhasin, Mohit ; Gauri, Andre ; Gottlieb, Charles ; Hotvedt, Peter ; Chaudhry, Muqtada ; Greenberg, Steven ; Tsai, W. Kevin ; Averbach, Marcus ; Cheong, Benjamin ; Mittal, Suneet ; Baker, James ; McGrew, Frank ; Kraus, David ; Skopicki, Hal ; Lee, Sung ; Gredler, Frank ; Islam, Jamal ; Mohiuddin, Syed M. ; Valderrabano, Miguel ; Nasir, Nadim ; Anderson, Daniel ; Niebauer, Mark ; Colon-Hernandez, Pedro ; Mackall, Judith ; Sandhu, Roopinder ; Ott, Peter ; Nayak, Hemal ; Dunlap, Stephanie ; Aranda, Juan ; Hsu, Steven ; Owens, Steven ; See, Vincent ; Menees, Daniel ; Flaker, Greg ; Saba, Samir ; Fong, Michael ; Aktas, Mehmet ; O'Brien, Terrence ; Bernstein, Victoria ; Saavedra, Pablo ; Koshy, Matthew ; Whalen, Sean ; Eldadah, Zayd ; Haines, David ; Marzo, Kevin. / Sudden death in patients with coronary heart disease without severe systolic dysfunction. In: JAMA Cardiology. 2018 ; Vol. 3, No. 7. pp. 591-600.
@article{e1a283c9e0c3472d80e6dfe8616f8f52,
title = "Sudden death in patients with coronary heart disease without severe systolic dysfunction",
abstract = "IMPORTANCE The majority of sudden and/or arrhythmic deaths (SAD) in patients with coronary heart disease occur in those without severe systolic dysfunction, for whom strategies for sudden death prevention are lacking. OBJECTIVE To provide contemporary estimates of SAD vs other competing causes of death in patients with coronary heart disease without severe systolic dysfunction to search for high-risk subgroups that might be targeted in future trials of SAD prevention. DESIGN, SETTING, AND PARTICIPANTS This prospective observational cohort study included 135 clinical sites in the United States and Canada. A total of 5761 participants with coronary heart disease who did not qualify for primary prevention implantable cardioverter defibrillator therapy based on left ventricular ejection fraction (LVEF) of more than 35{\%}or New York Heart Association (NYHA) heart failure class (LVEF >30{\%}, NYHA I). EXPOSURES Clinical risk factors measured at baseline including age, LVEF, and NYHA heart failure class. MAIN OUTCOMES AND MEASURES Primary outcome of SAD, which is a composite of SAD and resuscitated ventricular fibrillation arrest. RESULTS The mean (SD) age of the cohort was 64 (11) years. During a median of 3.9 years, the cumulative incidence of SAD and non-SAD was 2.1{\%}and 7.7{\%}, respectively. Sudden and/or arrhythmic death was the most common mode of cardiovascular death accounting for 114 of 202 cardiac deaths (56{\%}), although noncardiac death was the primary mode of death in this population. The 4-year cumulative incidence of SAD was lowest in those with an LVEF of more than 60{\%}(1.0{\%}) and highest among those with LVEF of 30{\%} to 40{\%} (4.9{\%}) and class III/IV heart failure (5.1{\%}); however, the cumulative incidence of non-SAD was similarly elevated in these latter high-risk subgroups. Patients with a moderately reduced LVEF (40{\%}-49{\%}) were more likely to die of SAD, whereas those with class II heart failure and advancing age were more likely to die of non-SAD. The proportion of deaths due to SAD varied widely, from 14{\%}(18 of 131 deaths) in patients with NYHA II to 49{\%}(37 of 76 deaths) in those younger than 60 years. CONCLUSIONS AND RELEVANCE In a contemporary population of patients with coronary heart disease without severe systolic dysfunction, SAD accounts for a significant proportion of overall mortality. Moderately reduced LVEF, age, and NYHA class distinguished SAD and non-SAD, whereas other markers were equally associated with both modes of death. Absolute and proportional risk of SAD varied significantly across clinical subgroups, and both will need to be maximized in future risk stratification efforts.",
author = "Chatterjee, {Neal A.} and Moorthy, {M. Vinayaga} and Julie Pester and Andi Schaecter and Panicker, {Gopi K.} and Dhiraj Narula and Lee, {Daniel C.} and Goldberger, {Jeffrey J.} and Alan Kadish and Cook, {Nancy R.} and Albert, {Christine M.} and Elbert, {Christine M.} and Sharan Mahal and John Sobolski and Sorin Danciu and Christopher Dyke and Robert Phang and David Wolinsky and Robert Biederman and Brent McLaurin and Benjamin Trichon and David Serfas and Azhar Aslam and William Bugni and Aziz Hany and Leng Jiang and Henri Marais and Sam Durr and Joel Reinoehl and Susan Graham and Diego Sadler and Norman Erenrich and Robert Spencer and Griffin, {John E.A.} and Chris Geohas and Treasure, {Charles B.} and Talal Baki and David Huneycutt and Walid Saliba and Svinarich, {J. Thomas} and William Whang and Preetham Jetty and Jeffrey Shanes and Joseph McGarvey and Shelley Hankins and White, {Lindsey L.} and David DeLurgio and Harischandra Karunaratne and Enrique Flores and Eve Gillespie and John McKenzie and Cezar Staniloae and Alexander Altschuller and Claudio Schuger and Michael Radin and Gerald Pohost and Mark Myers and Bunch, {T. Jared} and William Wickemeyer and Robert Mendelson and Ronald Berger and Terence Ross and Andrew Sumner and Lee Arcement and Bilal Malik and Ned Claxton and Kathryn Rohr and Robert Weiss and Raul Garcia-Rinaldi and John Kazmierski and David Rosenbaum and Ronald Blonder and Kodangudi Ramanathan and Geariod O'Neill and Kevin Cochran and Elizabeth Kaufman and Otto Costantini and Stephen Hustead and Zakir Sahul and James Bengston and Ellis Lader and Matthew Nora and Charles Gornick and Selcuk Adabag and Steven Tishler and Steven Klein and Gervasio Lamas and Mirza Baig and Michelle Ratliff and Sei Iwai and Glover Johnson and Thomas Oliver and Michael Langer and Joon Ahn and Silver, {Kevin H.} and Mattson, {Scott E.} and Jay Schmidt and Ramanathan, {P. Kasi} and John Heitner and Arthur Riba and Udho Thadani and Shujahat Shah and David Sandler and David Bello and Edward Mostel and Rajul Patel and Patrick Simpson and Terrence Hack and Charles Shoultz and Romel Figueredo and Mahmoud Atieh and John Herre and Mohit Bhasin and Andre Gauri and Charles Gottlieb and Peter Hotvedt and Muqtada Chaudhry and Steven Greenberg and Tsai, {W. Kevin} and Marcus Averbach and Benjamin Cheong and Suneet Mittal and James Baker and Frank McGrew and David Kraus and Hal Skopicki and Sung Lee and Frank Gredler and Jamal Islam and Mohiuddin, {Syed M.} and Miguel Valderrabano and Nadim Nasir and Daniel Anderson and Mark Niebauer and Pedro Colon-Hernandez and Judith Mackall and Roopinder Sandhu and Peter Ott and Hemal Nayak and Stephanie Dunlap and Juan Aranda and Steven Hsu and Steven Owens and Vincent See and Daniel Menees and Greg Flaker and Samir Saba and Michael Fong and Mehmet Aktas and Terrence O'Brien and Victoria Bernstein and Pablo Saavedra and Matthew Koshy and Sean Whalen and Zayd Eldadah and David Haines and Kevin Marzo",
year = "2018",
month = "7",
day = "1",
doi = "10.1001/jamacardio.2018.1049",
language = "English (US)",
volume = "3",
pages = "591--600",
journal = "JAMA Cardiology",
issn = "2380-6583",
publisher = "American Medical Association",
number = "7",

}

TY - JOUR

T1 - Sudden death in patients with coronary heart disease without severe systolic dysfunction

AU - Chatterjee, Neal A.

AU - Moorthy, M. Vinayaga

AU - Pester, Julie

AU - Schaecter, Andi

AU - Panicker, Gopi K.

AU - Narula, Dhiraj

AU - Lee, Daniel C.

AU - Goldberger, Jeffrey J.

AU - Kadish, Alan

AU - Cook, Nancy R.

AU - Albert, Christine M.

AU - Elbert, Christine M.

AU - Mahal, Sharan

AU - Sobolski, John

AU - Danciu, Sorin

AU - Dyke, Christopher

AU - Phang, Robert

AU - Wolinsky, David

AU - Biederman, Robert

AU - McLaurin, Brent

AU - Trichon, Benjamin

AU - Serfas, David

AU - Aslam, Azhar

AU - Bugni, William

AU - Hany, Aziz

AU - Jiang, Leng

AU - Marais, Henri

AU - Durr, Sam

AU - Reinoehl, Joel

AU - Graham, Susan

AU - Sadler, Diego

AU - Erenrich, Norman

AU - Spencer, Robert

AU - Griffin, John E.A.

AU - Geohas, Chris

AU - Treasure, Charles B.

AU - Baki, Talal

AU - Huneycutt, David

AU - Saliba, Walid

AU - Svinarich, J. Thomas

AU - Whang, William

AU - Jetty, Preetham

AU - Shanes, Jeffrey

AU - McGarvey, Joseph

AU - Hankins, Shelley

AU - White, Lindsey L.

AU - DeLurgio, David

AU - Karunaratne, Harischandra

AU - Flores, Enrique

AU - Gillespie, Eve

AU - McKenzie, John

AU - Staniloae, Cezar

AU - Altschuller, Alexander

AU - Schuger, Claudio

AU - Radin, Michael

AU - Pohost, Gerald

AU - Myers, Mark

AU - Bunch, T. Jared

AU - Wickemeyer, William

AU - Mendelson, Robert

AU - Berger, Ronald

AU - Ross, Terence

AU - Sumner, Andrew

AU - Arcement, Lee

AU - Malik, Bilal

AU - Claxton, Ned

AU - Rohr, Kathryn

AU - Weiss, Robert

AU - Garcia-Rinaldi, Raul

AU - Kazmierski, John

AU - Rosenbaum, David

AU - Blonder, Ronald

AU - Ramanathan, Kodangudi

AU - O'Neill, Geariod

AU - Cochran, Kevin

AU - Kaufman, Elizabeth

AU - Costantini, Otto

AU - Hustead, Stephen

AU - Sahul, Zakir

AU - Bengston, James

AU - Lader, Ellis

AU - Nora, Matthew

AU - Gornick, Charles

AU - Adabag, Selcuk

AU - Tishler, Steven

AU - Klein, Steven

AU - Lamas, Gervasio

AU - Baig, Mirza

AU - Ratliff, Michelle

AU - Iwai, Sei

AU - Johnson, Glover

AU - Oliver, Thomas

AU - Langer, Michael

AU - Ahn, Joon

AU - Silver, Kevin H.

AU - Mattson, Scott E.

AU - Schmidt, Jay

AU - Ramanathan, P. Kasi

AU - Heitner, John

AU - Riba, Arthur

AU - Thadani, Udho

AU - Shah, Shujahat

AU - Sandler, David

AU - Bello, David

AU - Mostel, Edward

AU - Patel, Rajul

AU - Simpson, Patrick

AU - Hack, Terrence

AU - Shoultz, Charles

AU - Figueredo, Romel

AU - Atieh, Mahmoud

AU - Herre, John

AU - Bhasin, Mohit

AU - Gauri, Andre

AU - Gottlieb, Charles

AU - Hotvedt, Peter

AU - Chaudhry, Muqtada

AU - Greenberg, Steven

AU - Tsai, W. Kevin

AU - Averbach, Marcus

AU - Cheong, Benjamin

AU - Mittal, Suneet

AU - Baker, James

AU - McGrew, Frank

AU - Kraus, David

AU - Skopicki, Hal

AU - Lee, Sung

AU - Gredler, Frank

AU - Islam, Jamal

AU - Mohiuddin, Syed M.

AU - Valderrabano, Miguel

AU - Nasir, Nadim

AU - Anderson, Daniel

AU - Niebauer, Mark

AU - Colon-Hernandez, Pedro

AU - Mackall, Judith

AU - Sandhu, Roopinder

AU - Ott, Peter

AU - Nayak, Hemal

AU - Dunlap, Stephanie

AU - Aranda, Juan

AU - Hsu, Steven

AU - Owens, Steven

AU - See, Vincent

AU - Menees, Daniel

AU - Flaker, Greg

AU - Saba, Samir

AU - Fong, Michael

AU - Aktas, Mehmet

AU - O'Brien, Terrence

AU - Bernstein, Victoria

AU - Saavedra, Pablo

AU - Koshy, Matthew

AU - Whalen, Sean

AU - Eldadah, Zayd

AU - Haines, David

AU - Marzo, Kevin

PY - 2018/7/1

Y1 - 2018/7/1

N2 - IMPORTANCE The majority of sudden and/or arrhythmic deaths (SAD) in patients with coronary heart disease occur in those without severe systolic dysfunction, for whom strategies for sudden death prevention are lacking. OBJECTIVE To provide contemporary estimates of SAD vs other competing causes of death in patients with coronary heart disease without severe systolic dysfunction to search for high-risk subgroups that might be targeted in future trials of SAD prevention. DESIGN, SETTING, AND PARTICIPANTS This prospective observational cohort study included 135 clinical sites in the United States and Canada. A total of 5761 participants with coronary heart disease who did not qualify for primary prevention implantable cardioverter defibrillator therapy based on left ventricular ejection fraction (LVEF) of more than 35%or New York Heart Association (NYHA) heart failure class (LVEF >30%, NYHA I). EXPOSURES Clinical risk factors measured at baseline including age, LVEF, and NYHA heart failure class. MAIN OUTCOMES AND MEASURES Primary outcome of SAD, which is a composite of SAD and resuscitated ventricular fibrillation arrest. RESULTS The mean (SD) age of the cohort was 64 (11) years. During a median of 3.9 years, the cumulative incidence of SAD and non-SAD was 2.1%and 7.7%, respectively. Sudden and/or arrhythmic death was the most common mode of cardiovascular death accounting for 114 of 202 cardiac deaths (56%), although noncardiac death was the primary mode of death in this population. The 4-year cumulative incidence of SAD was lowest in those with an LVEF of more than 60%(1.0%) and highest among those with LVEF of 30% to 40% (4.9%) and class III/IV heart failure (5.1%); however, the cumulative incidence of non-SAD was similarly elevated in these latter high-risk subgroups. Patients with a moderately reduced LVEF (40%-49%) were more likely to die of SAD, whereas those with class II heart failure and advancing age were more likely to die of non-SAD. The proportion of deaths due to SAD varied widely, from 14%(18 of 131 deaths) in patients with NYHA II to 49%(37 of 76 deaths) in those younger than 60 years. CONCLUSIONS AND RELEVANCE In a contemporary population of patients with coronary heart disease without severe systolic dysfunction, SAD accounts for a significant proportion of overall mortality. Moderately reduced LVEF, age, and NYHA class distinguished SAD and non-SAD, whereas other markers were equally associated with both modes of death. Absolute and proportional risk of SAD varied significantly across clinical subgroups, and both will need to be maximized in future risk stratification efforts.

AB - IMPORTANCE The majority of sudden and/or arrhythmic deaths (SAD) in patients with coronary heart disease occur in those without severe systolic dysfunction, for whom strategies for sudden death prevention are lacking. OBJECTIVE To provide contemporary estimates of SAD vs other competing causes of death in patients with coronary heart disease without severe systolic dysfunction to search for high-risk subgroups that might be targeted in future trials of SAD prevention. DESIGN, SETTING, AND PARTICIPANTS This prospective observational cohort study included 135 clinical sites in the United States and Canada. A total of 5761 participants with coronary heart disease who did not qualify for primary prevention implantable cardioverter defibrillator therapy based on left ventricular ejection fraction (LVEF) of more than 35%or New York Heart Association (NYHA) heart failure class (LVEF >30%, NYHA I). EXPOSURES Clinical risk factors measured at baseline including age, LVEF, and NYHA heart failure class. MAIN OUTCOMES AND MEASURES Primary outcome of SAD, which is a composite of SAD and resuscitated ventricular fibrillation arrest. RESULTS The mean (SD) age of the cohort was 64 (11) years. During a median of 3.9 years, the cumulative incidence of SAD and non-SAD was 2.1%and 7.7%, respectively. Sudden and/or arrhythmic death was the most common mode of cardiovascular death accounting for 114 of 202 cardiac deaths (56%), although noncardiac death was the primary mode of death in this population. The 4-year cumulative incidence of SAD was lowest in those with an LVEF of more than 60%(1.0%) and highest among those with LVEF of 30% to 40% (4.9%) and class III/IV heart failure (5.1%); however, the cumulative incidence of non-SAD was similarly elevated in these latter high-risk subgroups. Patients with a moderately reduced LVEF (40%-49%) were more likely to die of SAD, whereas those with class II heart failure and advancing age were more likely to die of non-SAD. The proportion of deaths due to SAD varied widely, from 14%(18 of 131 deaths) in patients with NYHA II to 49%(37 of 76 deaths) in those younger than 60 years. CONCLUSIONS AND RELEVANCE In a contemporary population of patients with coronary heart disease without severe systolic dysfunction, SAD accounts for a significant proportion of overall mortality. Moderately reduced LVEF, age, and NYHA class distinguished SAD and non-SAD, whereas other markers were equally associated with both modes of death. Absolute and proportional risk of SAD varied significantly across clinical subgroups, and both will need to be maximized in future risk stratification efforts.

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U2 - 10.1001/jamacardio.2018.1049

DO - 10.1001/jamacardio.2018.1049

M3 - Article

VL - 3

SP - 591

EP - 600

JO - JAMA Cardiology

JF - JAMA Cardiology

SN - 2380-6583

IS - 7

ER -