Abstract 15847: Identifying the Symptomatic Middle-aged Subject at Imminent Risk of Sudden Cardiac Arrest
Introduction: We have recently reported a high rate of warning symptoms in the four weeks preceding sudden cardiac arrest (SCA), that are ignored by the majority of victims. Importantly, an immediate 911 call resulted in a significant better survival outcome.
Hypothesis: Since symptoms alone can be quite non-specific, we hypothesized the existence of a symptom-clinical profile complex that could facilitate the identification of the patient at high risk of impending SCA.
Methods: SCA cases from a large population based study in the US Northwest (approx. 1 million population, 2002-2015) were included if age 35-65 yrs, and with warning symptoms during the 4 weeks prior to the SCA event. Geographic controls were required to have presented with acute coronary syndrome (ACS), without history of ventricular arrhythmias or SCA. Demographics, social history, clinical profile, medications and measures of cardiac function were evaluated.
Results: 320 SCD cases and 223 controls of similar sex distribution were included. For cases, warning symptoms included chest pain (46%), dyspnea (18%), syncope/palpitation (6%) and others (30%). Cases were younger (53 vs 56yrs), with higher rates of heart failure (20 vs 14%), current smoking (59 vs 49%), heavy alcohol use (33 vs 21%), and beta-2 agonists and QT-prolonging drug use (19 vs 13% and 43 vs 33%, respectively) (p≤0.05). Controls had higher incidence of known cardiovascular risk factors [HTN, hyperlipidemia , MI (p≤0.01), diabetes (p=0.09)] and use of cardiovascular drugs (beta-blockers, ACEI, ARBs, statins and anti-platelet therapy) (p≤0.01). Cases had longer mean QTc (459 vs 437 ms), QRS (100 vs 94 ms), Tpeak-end (89 vs 78 ms), and LVH by ECGs or echocardiograms (p≤0.004), trending towards lower LV ejection fraction (49 vs 53%, p=0.09). Among cases, 28% had known coronary disease, 23% history of MI and 16% had ACS at the time of SCA.
Conclusions: There may be a window of opportunity to prevent SCA by enhancing “near term” prevention among patients with warning signs during the 4 weeks prior to SCA. These findings may enable the identification of the patient at impending risk of SCA, and prospective evaluation is warranted.
Author Disclosures: A. Uy-Evanado: None. K. Reinier: None. A. Aro: None. E.C. Stecker: Research Grant; Significant; NIH. C. Teodorescu: None. K. Gunson: None. J. Jui: None. S.S. Chugh: Research Grant; Significant; NIH (NHLBI), R01HL126938 and R01HL122492.
- © 2016 by American Heart Association, Inc.