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 McLaurinBenjamin 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 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

11 Scopus citations

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 2018

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

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    Chatterjee, N. A., Moorthy, M. V., Pester, J., Schaecter, A., Panicker, G. K., Narula, D., Lee, D. C., Goldberger, J. J., Kadish, A., Cook, N. R., Albert, C. M., Elbert, C. M., Mahal, S., Sobolski, J., Danciu, S., Dyke, C., Phang, R., Wolinsky, D., Biederman, R., ... 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