Abstract 804: Sudden Cardiac Death and Severity of Obstructive Coronary Artery Disease: A Report From the NHLBI-Sponsored Women’s Ischemia Syndrome Evaluation (WISE) Study
Objectives: Sudden cardiac death (SCD) is a major health problem that has received less attention than MI. We report the incidence of SCD in women with and without obstructive CAD in the WISE.
Methods: A total of 904 women referred for coronary angiography for symptoms of myocardial ischemia were prospectively followed for a median of 5.9 years. The WISE angiographic core laboratory classified the women as having no (<20%), minimal (20 – 49%), or obstructive CAD (≥50% stenosis). During annual follow-up, if the woman was found to be deceased, we obtained a death certificate and/or physician narrative, or family account of the circumstances of death. A WISE mortality committee, blinded to diagnostic information, rated all deaths as cardiovascular (CV) versus non-CV; where possible, CV deaths were further adjudicated as SCD vs non-SCD. SCD was defined as unwitnessed unexplained non-hospital death; sudden, massive or acute MI; or in-hospital cardiac arrest related to complications or procedures.
Results: Mean age was 58±12 years, 19% were non-white, and 96 (11%) died: 28 of non-CV causes, 59 of CV causes, and 9 lacked documentation to classify deaths. Among the 42 classifiable CV deaths, 25 (60%) were SCD. The number of deaths increased by increasing CAD severity (p<0.0001) (Table⇓). However, among women who died, CV deaths were high even in women with <20% stenosis (50%), and the percent of SCD was equally distributed across the CAD severity groups (p=0.33). Family history of premature death did not differ between those with SCD versus other CV deaths (p=0.72).
Conclusions: Among women referred for coronary angiography, overall and CV mortality increases with increasing CAD severity. However, symptomatic women without obstructive CAD are not risk free. Future research is needed into the pathophysiology of SCD in women. Recent AHA guidelines for risk factor reduction, even in women without obstructive CAD, and public education in the use of AEDs should be prioritized.