Risk of sudden versus nonsudden cardiac death in patients with coronary artery disease.
BACKGROUND
Patients at high risk of sudden cardiac death, yet at low risk of nonsudden death, might be ideal candidates for antiarrhythmic drugs or devices. Most previous studies of prognostic markers for sudden cardiac death have ignored the competitive risk of nonsudden cardiac death. The goal of the present study was to evaluate the ability of clinical factors to distinguish the risks of sudden and nonsudden cardiac death.


METHODS
We identified all deaths during a 3.3-year follow-up of 30,680 patients discharged alive after admission to the cardiac care unit of a Seattle hospital. Detailed chart reviews were conducted on 1093 subsequent out-of-hospital sudden deaths, 973 nonsudden cardiac deaths, and 442 randomly selected control patients.


RESULTS
Patients who died in follow-up (suddenly or nonsuddenly) were significantly different for many clinical factors from control patients. In contrast, patients with sudden cardiac death were insignificantly different for most clinical characteristics from patients with nonsudden cardiac death. The mode of death was 20% to 30% less likely to be sudden in women, patients who had angioplasty or bypass surgery, and patients prescribed beta-blockers. The mode of death was 20% to 30% more likely to be sudden in patients with heart failure, frequent ventricular ectopy, or a discharge diagnosis of acute myocardial infarction. A multivariable model had only modest predictive capacity for mode of death (c-index of 0.62).


CONCLUSIONS
Standard clinical evaluation is much better at predicting overall risk of death than at predicting the mode of death as sudden or nonsudden.
Every
Nathan
N
Department of Biostatistics, Northwest Health Services Research and Development Center of Excellence, VA Puget Sound Healthcare System, University of Washington, Seattle, Wash, USA.
Hallstrom
Alfred
A
McDonald
Kathryn M
KM
Parsons
Lori
L
Thom
David
D
Weaver
Douglas
D
Hlatky
Mark A
MA
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D015906:Angioplasty, Balloon, Coronary / Q000706:statistics & numerical data; D002423:Cause of Death; D001026:Coronary Artery Bypass / Q000706:statistics & numerical data; D003327:Coronary Disease / Q000175:diagnosis* / Q000401:mortality* / Q000628:therapy; D003645:Death, Sudden / Q000453:epidemiology*; D005260:Female; D006333:Heart Failure / Q000453:epidemiology / Q000401:mortality; D006760:Hospitalization; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D012307:Risk Factors; D012494:Sampling Studies; D012737:Sex Factors; D014861:Washington / Q000453:epidemiology
D000319:Adrenergic beta-Antagonists