PMID- 29801082 OWN - NLM STAT- MEDLINE DCOM- 20190926 LR - 20190926 IS - 2380-6591 (Electronic) IS - 2380-6583 (Print) VI - 3 IP - 7 DP - 2018 Jul 1 TI - Sudden Death in Patients With Coronary Heart Disease Without Severe Systolic Dysfunction. PG - 591-600 LID - 10.1001/jamacardio.2018.1049 [doi] 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. FAU - Chatterjee, Neal A AU - Chatterjee NA AD - Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts. AD - Massachusetts General Hospital, Harvard Medical School, Boston. FAU - Moorthy, M Vinayaga AU - Moorthy MV AD - Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts. FAU - Pester, Julie AU - Pester J AD - Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts. FAU - Schaecter, Andi AU - Schaecter A AD - Northwestern University Feinberg School of Medicine, Chicago, Illinois. FAU - Panicker, Gopi K AU - Panicker GK AD - Cardiac Safety Services, Quintiles, Mumbai, India. FAU - Narula, Dhiraj AU - Narula D AD - Healthcare Partners Cardiology Group, Las Vegas, Nevada. FAU - Lee, Daniel C AU - Lee DC AD - Northwestern University Feinberg School of Medicine, Chicago, Illinois. FAU - Goldberger, Jeffrey J AU - Goldberger JJ AD - University of Miami Miller School of Medicine, Miami, Florida. FAU - Kadish, Alan AU - Kadish A AD - Touro College and University System, New York, New York. FAU - Cook, Nancy R AU - Cook NR AD - Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts. FAU - Albert, Christine M AU - Albert CM AD - Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts. CN - PRE-DETERMINE Study Group LA - eng GR - R01 HL091069/HL/NHLBI NIH HHS/United States GR - R01 HL116690/HL/NHLBI NIH HHS/United States PT - Journal Article PT - Multicenter Study PT - Research Support, N.I.H., Extramural PT - Research Support, Non-U.S. Gov't PL - United States TA - JAMA Cardiol JT - JAMA cardiology JID - 101676033 SB - IM CIN - JAMA Cardiol. 2018 Jul 1;3(7):556-558. PMID: 29800957 EIN - JAMA Cardiol. 2018 Sep 1;3(9):898. PMID: 29998284 MH - Canada/epidemiology MH - Coronary Disease/*complications/mortality MH - Death, Sudden, Cardiac/*epidemiology/etiology MH - Female MH - Follow-Up Studies MH - Humans MH - Incidence MH - Male MH - Middle Aged MH - Prospective Studies MH - Risk Assessment/*methods MH - Risk Factors MH - Survival Rate/trends MH - Systole MH - United States/epidemiology MH - Ventricular Dysfunction, Left MH - Ventricular Function, Left/*physiology PMC - PMC6145665 COIS- Conflict of Interest Disclosures: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Dr Narula reports personal fees from Quintiles Cardiac Safety Services during the conduct of the study. Dr Lee reports receiving grants from St Jude Medical and National Institutes of Health. Dr Goldberger is the director of Path to Improved Risk Stratification. Dr Albert reports receiving grants from St Jude Medical, National Institutes of Health, and Roche Diagnostics outside the submitted work. No other disclosures were reported. EDAT- 2018/05/26 06:00 MHDA- 2019/09/27 06:00 PMCR- 2019/05/02 CRDT- 2018/05/26 06:00 PHST- 2018/05/26 06:00 [pubmed] PHST- 2019/09/27 06:00 [medline] PHST- 2018/05/26 06:00 [entrez] PHST- 2019/05/02 00:00 [pmc-release] AID - 2679908 [pii] AID - hoi180018 [pii] AID - 10.1001/jamacardio.2018.1049 [doi] PST - ppublish SO - JAMA Cardiol. 2018 Jul 1;3(7):591-600. doi: 10.1001/jamacardio.2018.1049.