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Sudden cardiac death common cause of CV death after NSTEACS
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Approximately one-third of CV deaths after non–ST-segment elevation ACS are from sudden cardiac death, according to findings published in JAMA Cardiology.
Researchers analyzed data from 37,555 participants (median age, 65 years; 67.4% men) with non–ST-segment elevation ACS (NSTEACS) in the APPRAISE-2, PLATO, TRACER and TRILOGY ACS trials to determine cumulative incidence of CV death and sudden cardiac death according to time after NSTEACS and to develop a risk model.
After a median follow-up of 12.1 months, there were 2,109 deaths in the study population, with 1,640 being CV deaths, according to Paul L. Hess, MD, MHS, and colleagues.
Of the CV deaths, 513 (31.3%) were from sudden cardiac death, Hess, from Veterans Affairs Eastern Colorado and Health Care System, Denver, and the department of medicine, University of Colorado School of Medicine, Aurora, and colleagues found.
They estimated the cumulative incidence of sudden cardiac death in this population as 0.79% at 6 months, 1.65% at 18 months and 2.37% at 30 months.
They found the following characteristics to be significantly associated with sudden cardiac death in the study population: reduced left ventricular ejection fraction, older age, diabetes, lower estimated glomerular filtration rate, higher heart rate, past MI, peripheral artery disease, Asian race, male sex and high Killip class.
When they constructed a model based on those factors to calculate risk for sudden cardiac death, they found that the full model had a C-index of 0.77, and a modified, integer-based risk score without LVEF had a C-index of 0.75. Using that score, they determined that the 2-year risk for sudden cardiac death in the study population ranged from 0.1% to 56.7%, with 51% of patients having a risk of less than 1%.
When Hess and colleagues constructed a multivariable model including time-dependent clinical events after the initial hospitalization for ACS, they found that sudden cardiac death was associated with recurrent MI (HR = 2.95; 95% CI, 2.29-3.8) and any hospitalization (HR = 2.45; 95% CI, 1.98-3.03).
Conversely, those who had coronary revascularization were less likely to experience sudden cardiac death (HR = 0.75; 95% CI, 0.58-0.98), they found.
“With certain clinical risk factors associated with [sudden cardiac death], the development of a comprehensive risk-stratification tool that accounts for [sudden cardiac death]-associated clinical characteristics and produces a user-friendly risk score may be helpful in NSTEACS clinical care and research,” Hess and colleagues wrote. “First, this tool may be used to support treatment and counseling of individual patients. Second, it may help select patients in whom devices aimed at preventing [sudden cardiac death], such as [implantable cardioverter defibrillators] or wearable defibrillators, could be further studied.” – by Erik Swain
Disclosure: The present study and TRACER were funded by Merck. APPRAISE-2 was funded by Bristol-Myers Squibb and Pfizer. PLATO was funded by AstraZeneca. TRILOGY ACS was funded by Eli Lilly and Daiichi Sankyo. Hess reports receiving an honorarium from Sanofi. Please see the full study for a list of the other researchers’ relevant financial disclosures.
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