Abstract 2874: Sudden Cardiac Death in Patients with Stable Coronary Disease and Preserved Left Ventricular Systolic Function
Introduction: Although sudden cardiac death has been extensively studied in patients with coronary disease and low ejection fraction, predictors of sudden cardiac death among individuals with preserved LV systolic function are less well understood. We assessed the hypothesis that clinical characteristics can identify individuals with stable coronary heart disease and preserved left ventricular systolic function who are at high risk for sudden cardiac death.
Methods: We randomized 8290 stable coronary disease patients with preserved left ventricular systolic function to trandolapril or placebo into the Prevention of Events with ACE inhibition (PEACE) trial, used Cox proportional hazards models to identify independent baseline predictors of sudden cardiac death, and developed a risk score to identify individuals at high risk for sudden cardiac death.
Results: At baseline, mean age was 64 ± 8y and LV ejection fraction 58 ± 9%; 82% of participants were male and 93% Caucasian. During 4.8 year follow up, 127 participants died suddenly. Independent determinants of sudden cardiac death are shown (Table⇓). Trandolapril neither increased nor decreased sudden cardiac death. We categorized individuals using a risk score which awarded points as shown in the Table’s right column. For individuals with 0 –3 points (72% of the cohort, 52 events), estimated risk of sudden cardiac death at 4y was 0.8% (95% CI 0.6 –1.0), for 4 – 6 points (25% of the cohort, 56 events), estimated risk was 2.2% (95% CI 1.7–3.0), and for > 6 points (2.5% of the cohort, 19 events), estimated risk was 10.4% (95% CI 6.7–15.8). Kaplan-Meier curves for the three risk categories differed significantly (p < .05).
Conclusions - Among stable coronary patients with preserved left ventricular systolic function receiving current standard-of-care including coronary revascularization, clinical characteristics can identify individuals at higher risk for sudden cardiac death without the need for specialized testing.