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Sudden cardiac death affects women regardless of obstructive CAD
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Sudden cardiac death contributes to mortality in women regardless of whether they have obstructive CAD, according to a study published in the Journal of the American Heart Association.
“Despite study limitations discussed in the manuscript, findings indicate that in women with preserved ejection fraction, sudden cardiac death is a health threat regardless of angiographic CAD status,” Puja K. Mehta, MD, assistant professor of medicine in the division of cardiology at Emory University School of Medicine, director of women’s translational cardiovascular research at Emory Women’s Heart Center and Cardiology Today Next Gen Innovator, said in an interview.
Researchers analyzed data from 904 women (mean age, 58 years) from the WISE study with suspected ischemic heart disease who underwent invasive coronary angiography. Women were defined as having no CAD (n = 328), minimal CAD (n = 223) or obstructive CAD (n = 353) by WISE angiographic core laboratory. Follow-up phone interviews were conducted at 6 weeks and annually for a median of 6 years.
During follow-up, 11% of women died, of which 68% were CV-related. Sudden cardiac death accounted for 42% of CV deaths.
The rate of all-cause death was 5.8 in women with no CAD, 15.9 in those with minimal CAD and 38.6 in women with obstructive CAD (P < .0001). However, the rate of sudden cardiac death among women who died from CV-related causes was similar in women with no CAD (40%), minimal CAD (58%) and obstructive CAD (38%).
Multivariate modeling including all groups of CAD severity showed that a longer corrected QT interval (HR per 10 ms = 1.13; 95% CI, 1.02-1.26) and a history of depression (HR = 2.66; 95% CI, 1.19-5.95) were independent predictors of sudden cardiac death. When the model was further adjusted to include CAD severity in women without obstructive CAD, corrected QT interval remained an independent predictor of sudden cardiac death (HR = 1.22; 95% CI, 1.02-1.47).
“In addition to mounting evidence in the literature from various large cohorts, it is clear that the finding of no obstructive CAD is not completely benign in symptomatic subjects who have evidence of ischemia,” Mehta told Cardiology Today. “Clinicians should identify and treat traditional CAD risk factors in women with and without obstructive CAD. QTc interval was a single independent sudden cardiac death risk factor in women without obstructive CAD in this cohort, so interventions that target QTc should be studied further in this group.” – by Darlene Dobkowski
Disclosures: Mehta reports she receives research funding General Electric and Gilead. Please see the study for all other authors’ relevant financial disclosures.
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