Sudden cardiac death in patients with stable coronary artery disease and preserved left ventricular systolic function.
Although sudden cardiac death (SCD) has been extensively studied in patients with coronary artery disease (CAD) and low ejection fraction, prediction of SCD among individuals with preserved left ventricular systolic function is less well understood. We randomized 8,290 patients with stable CAD with preserved left ventricular systolic function to trandolapril or placebo in a secondary coronary prevention trial, and we used Cox proportional hazards models to identify independent baseline predictors of SCD during 4.8 year follow-up (median). Using a risk scoring algorithm based on simple clinical characteristics, we were able to distinguish individuals at higher risk for SCD. Independent determinants of SCD included age (p <0.001), current angina pectoris (p = 0.002), ejection fraction >40% to <50% (as opposed to >50%) (p <0.001), and diuretic (p <0.001) and digitalis use (p <0.001). Negative predictors included having prior coronary revascularization (p = 0.01) and being female (p = 0.02) or Caucasian (p = 0.006). Trandolapril neither increased nor decreased SCD. Thus, among patients with stable CAD with preserved left ventricular systolic function receiving current standard-of-care including coronary revascularization, clinical characteristics can identify individuals at higher risk for SCD.
Hsia
Judith
J
Department of Medicine, George Washington University, Washington, DC, USA. judith.hsia@astrazeneca.com
Jablonski
Kathleen A
KA
Rice
Madeline Murguia
MM
Sabatine
Marc S
MS
Zabalgoitia
Miguel
M
Maggioni
Aldo
A
Cuddy
Thomas E
TE
Domanski
Michael J
MJ
Geller
Nancy L
NL
Flaker
Greg
G
Solomon
Scott
S
Omland
Torbjørn
T
Rouleau
Jean L
JL
D000367:Age Factors; D000465:Algorithms; D000787:Angina Pectoris / Q000453:epidemiology; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D002316:Cardiotonic Agents / Q000627:therapeutic use; D003324:Coronary Artery Disease / Q000188:drug therapy / Q000401:mortality* / Q000503:physiopathology; D016757:Death, Sudden, Cardiac; D004071:Digitalis Glycosides / Q000627:therapeutic use; D004232:Diuretics / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007211:Indoles / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D009204:Myocardial Revascularization; D016016:Proportional Hazards Models; D044469:Racial Groups; D018570:Risk Assessment; D012737:Sex Factors; D013318:Stroke Volume; D013599:Systole / Q000502:physiology; D016277:Ventricular Function, Left / Q000502:physiology*
D000806:Angiotensin-Converting Enzyme Inhibitors; D002316:Cardiotonic Agents; D004071:Digitalis Glycosides; D004232:Diuretics; D007211:Indoles; C052035:trandolapril