Sudden death in patients with coronary heart disease without severe systolic dysfunction

Neal A. Chatterjee; M. Vinayaga Moorthy; Julie Pester; Andi Schaecter; Gopi K. Panicker; Dhiraj Narula; Daniel C. Lee; Jeffrey J. Goldberger; Alan Kadish; Nancy R. Cook; Christine M. Albert; Christine M. Elbert; Sharan Mahal; John Sobolski; Sorin Danciu; Christopher Dyke; Robert Phang; David Wolinsky; Robert Biederman; Brent McLaurin; Benjamin Trichon; David Serfas; Azhar Aslam; William Bugni; Aziz Hany; Leng Jiang; Henri Marais; Sam Durr; Joel Reinoehl; Susan Graham; Diego Sadler; Norman Erenrich; Robert Spencer; John E.A. Griffin; Chris Geohas; Charles B. Treasure; Talal Baki; David Huneycutt; Walid Saliba; J. Thomas Svinarich; William Whang; Preetham Jetty; Jeffrey Shanes; Joseph McGarvey; Shelley Hankins; Lindsey L. White; David DeLurgio; Harischandra Karunaratne; Enrique Flores; Eve Gillespie; John McKenzie; Cezar Staniloae; Alexander Altschuller; Claudio Schuger; Michael Radin; Gerald Pohost; Mark Myers; T. Jared Bunch; William Wickemeyer; Robert Mendelson; Ronald Berger; Terence Ross; Andrew Sumner; Lee Arcement; Bilal Malik; Ned Claxton; Kathryn Rohr; Robert Weiss; Raul Garcia-Rinaldi; John Kazmierski; David Rosenbaum; Ronald Blonder; Kodangudi Ramanathan; Geariod O'Neill; Kevin Cochran; Elizabeth Kaufman; Otto Costantini; Stephen Hustead; Zakir Sahul; James Bengston; Ellis Lader; Matthew Nora; Charles Gornick; Selcuk Adabag; Steven Tishler; Steven Klein; Gervasio Lamas; Mirza Baig; Michelle Ratliff; Sei Iwai; Glover Johnson; Thomas Oliver; Michael Langer; Joon Ahn; Kevin H. Silver; Scott E. Mattson; Jay Schmidt; P. Kasi Ramanathan; John Heitner; Arthur Riba; Udho Thadani; Shujahat Shah; David Sandler; David Bello; Edward Mostel; Rajul Patel; Patrick Simpson; Terrence Hack; Charles Shoultz; Romel Figueredo; Mahmoud Atieh; John Herre; Mohit Bhasin; Andre Gauri; Charles Gottlieb; Peter Hotvedt; Muqtada Chaudhry; Steven Greenberg; W. Kevin Tsai; Marcus Averbach; Benjamin Cheong; Suneet Mittal; James Baker; Frank McGrew; David Kraus; Hal Skopicki; Sung Lee; Frank Gredler; Jamal Islam; Syed Mohiuddin; Miguel Valderrabano; Nadim Nasir; Daniel Anderson; Mark Niebauer; Pedro Colon-Hernandez; Judith Mackall; Roopinder Sandhu; Peter Ott; Hemal Nayak; Stephanie Dunlap; Juan Aranda; Steven Hsu; Steven Owens; Vincent See; Daniel Menees; Greg Flaker; Samir Saba; Michael Fong; Mehmet Aktas; Terrence O'Brien; Victoria Bernstein; Pablo Saavedra; Matthew Koshy; Sean Whalen; Zayd Eldadah; David Haines; Kevin Marzo

doi:10.1001/jamacardio.2018.1049

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Sudden death in patients with coronary heart disease without severe systolic dysfunction

Journal article

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Sudden death in patients with coronary heart disease without severe systolic dysfunction

Neal A. Chatterjee, M. Vinayaga Moorthy, Julie Pester, Andi Schaecter, Gopi K. Panicker, Dhiraj Narula, Daniel C. Lee, Jeffrey J. Goldberger, Alan Kadish, Nancy R. Cook, …

JAMA Cardiology, Vol.3(7), pp.591-600

07/2018

DOI: https://doi.org/10.1001/jamacardio.2018.1049

PMID: 29801082

Abstract

Cardiology and Cardiovascular Medicine

IMPORTANCE The majority of sudden and/or arrhythmic deaths (SAD) in patients with coronary heart disease occur in those without severe systolic dysfunction, for whom strategies for sudden death prevention are lacking. OBJECTIVE To provide contemporary estimates of SAD vs other competing causes of death in patients with coronary heart disease without severe systolic dysfunction to search for high-risk subgroups that might be targeted in future trials of SAD prevention. DESIGN, SETTING, AND PARTICIPANTS This prospective observational cohort study included 135 clinical sites in the United States and Canada. A total of 5761 participants with coronary heart disease who did not qualify for primary prevention implantable cardioverter defibrillator therapy based on left ventricular ejection fraction (LVEF) of more than 35%or New York Heart Association (NYHA) heart failure class (LVEF >30%, NYHA I). EXPOSURES Clinical risk factors measured at baseline including age, LVEF, and NYHA heart failure class. MAIN OUTCOMES AND MEASURES Primary outcome of SAD, which is a composite of SAD and resuscitated ventricular fibrillation arrest. RESULTS The mean (SD) age of the cohort was 64 (11) years. During a median of 3.9 years, the cumulative incidence of SAD and non-SAD was 2.1%and 7.7%, respectively. Sudden and/or arrhythmic death was the most common mode of cardiovascular death accounting for 114 of 202 cardiac deaths (56%), although noncardiac death was the primary mode of death in this population. The 4-year cumulative incidence of SAD was lowest in those with an LVEF of more than 60%(1.0%) and highest among those with LVEF of 30% to 40% (4.9%) and class III/IV heart failure (5.1%); however, the cumulative incidence of non-SAD was similarly elevated in these latter high-risk subgroups. Patients with a moderately reduced LVEF (40%-49%) were more likely to die of SAD, whereas those with class II heart failure and advancing age were more likely to die of non-SAD. The proportion of deaths due to SAD varied widely, from 14%(18 of 131 deaths) in patients with NYHA II to 49%(37 of 76 deaths) in those younger than 60 years. CONCLUSIONS AND RELEVANCE In a contemporary population of patients with coronary heart disease without severe systolic dysfunction, SAD accounts for a significant proportion of overall mortality. Moderately reduced LVEF, age, and NYHA class distinguished SAD and non-SAD, whereas other markers were equally associated with both modes of death. Absolute and proportional risk of SAD varied significantly across clinical subgroups, and both will need to be maximized in future risk stratification efforts.

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Title: Sudden death in patients with coronary heart disease without severe systolic dysfunction
Creators: Neal A. Chatterjee (Author) - Harvard University
M. Vinayaga Moorthy (Author) - Harvard University
Julie Pester (Author) - Harvard University
Andi Schaecter (Author) - Northwestern University
Gopi K. Panicker (Author) - IQVIA Inc.
Dhiraj Narula (Author) - Healthcare Partners Cardiology Group
Daniel C. Lee (Author) - Northwestern University
Jeffrey J. Goldberger (Author) - University of Miami
Alan Kadish (Author) - Touro College and University System
Nancy R. Cook (Author) - Harvard University
Christine M. Albert (Author) - Harvard University
Christine M. Elbert (Author) - Harvard University
Sharan Mahal (Author) - Advanced Heartcare LLC
John Sobolski (Author) - Advocate Medical Group
Sorin Danciu (Author) - Advocate Medical Group Heart and Vascular of Illinois
Christopher Dyke (Author) - Alaska Heart Institute
Robert Phang (Author) - Albany Associates in Cardiology
David Wolinsky (Author) - Albany Associates in Cardiology
Robert Biederman (Author) - Allegheny General Hospital
Brent McLaurin (Author) - An Med Health
Benjamin Trichon (Author) - Asheville Cardiology Associates
David Serfas (Author) - Asheville Cardiology Associates
Azhar Aslam (Author) - Baptist Health Lexington
William Bugni (Author) - Bay Area Cardiology Associates
Aziz Hany (Author) - Baystate Cardiology
Leng Jiang (Author) - Care Clinical Research
Henri Marais (Author) - Black Hills Cardiovascular Research
Sam Durr (Author) - Harvard University
Joel Reinoehl (Author) - Bronson Hospital/Advanced Cardiac Healthcare
Susan Graham (Author) - Buffalo General Medical Center
Diego Sadler (Author) - Cleveland Clinic Foundation
Norman Erenrich (Author) - Cleveland Clinic Foundation
Robert Spencer (Author) - Cardiology Consultants of Northwest Florid/Langhornea
John E.A. Griffin (Author) - Cardiovascular Associates Virginia Beach
Chris Geohas (Author) - Cardiovascular Consultants
Charles B. Treasure (Author) - Cardiovascular Research of Knoxville
Talal Baki (Author) - Carolina Cardiology Associates
David Huneycutt (Author) - Centennial Heart
Walid Saliba (Author) - Cleveland Clinic Foundation
J. Thomas Svinarich (Author) - Colorado Heart and Vascular/Rocky Mountain Cardiovascular Associates
William Whang (Author) - Columbia University
Preetham Jetty (Author) - Community Heart AndVascular
Jeffrey Shanes (Author) - Consultants In Cardiovascular Medicine
Joseph McGarvey (Author) - Doylestown Cardiology Associates-VIAA
Shelley Hankins (Author) - Drexel University
Lindsey L. White (Author) - Eastern Carolina Cardiovascular Associates
David DeLurgio (Author) - Emory University
Harischandra Karunaratne (Author) - AdventHealth Orlando
Enrique Flores (Author) - Georgia Heart Specialist
Eve Gillespie (Author) - Glacier View Cardiology
John McKenzie (Author) - Glendale Hospital
Cezar Staniloae (Author) - Gotham Cardiovascular
Alexander Altschuller (Author) - Hawthorn Medical Associates
Claudio Schuger (Author) - Henry Ford Health System
Michael Radin (Author) - Hoag Memorial Hospital
Gerald Pohost (Author) - Hollywood Heart and Vascular
Mark Myers (Author) - Huntington Memorial Hospital
T. Jared Bunch (Author) - Primary Children's Medical Center
William Wickemeyer (Author) - Iowa Heart Center
Robert Mendelson (Author) - Jamaica Hospital Medical Center
Ronald Berger (Author) - Johns Hopkins University
Terence Ross (Author) - King's Daughters Medical Center
Andrew Sumner (Author) - Valley Hospital
Lee Arcement (Author) - Leonard J. Chabert Medical Center
Bilal Malik (Author) - Maimonides Medical Center
Ned Claxton (Author) - Maine Research Associates
Kathryn Rohr (Author) - Maine Research Associates
Robert Weiss (Author) - Maine Research Associates
Raul Garcia-Rinaldi (Author) - Mayaguez Medical Center
John Kazmierski (Author) - McLaren Medical Center-Macomb
David Rosenbaum (Author) - Memorial Health System
Ronald Blonder (Author) - Memorial Health System
Kodangudi Ramanathan (Author) - Department of Veterans Affairs
Geariod O'Neill (Author) - Mercy Hospital/Regional Cardiology Associates
Kevin Cochran (Author) - Mercy Medical Associates
Elizabeth Kaufman (Author) - Case Western Reserve University
Otto Costantini (Author) - Case Western Reserve University
Stephen Hustead (Author) - Metropolitan Cardiology Consultants
Zakir Sahul (Author) - Michigan Heart
James Bengston (Author) - Michigan Heart
Ellis Lader (Author) - Mid Valley Cardiology
Matthew Nora (Author) - Midwest Heart Foundation
Charles Gornick (Author) - Minneapolis Heart Institute
Selcuk Adabag (Author) - VA Medical Center
Steven Tishler (Author) - Steven Tshler Medicine Professional Corporation
Steven Klein (Author) - Moses Cone Hospital
Gervasio Lamas (Author) - Icahn School of Medicine at Mount Sinai
Mirza Baig (Author) - NECCR Internal Medicine and Cardiology Associates LLC
Michelle Ratliff (Author) - NewMexico VAHealthcare Systems
Sei Iwai (Author) - Cornell University
Glover Johnson (Author) - Non-invasive Cardiovascular PA
Thomas Oliver (Author) - North Cascade Cardiology
Michael Langer (Author) - North Ohio Heart Center
Joon Ahn (Author) - Northeast Georgia Medical Center
Kevin H. Silver (Author) - Northeast Ohio Cardiovascular Specialists
Scott E. Mattson (Author) - Northern Indiana Research Alliance/Lutheran
Jay Schmidt (Author) - North State Clinical Research
P. Kasi Ramanathan (Author) - ProMedica Health System
John Heitner (Author) - NewYork-Presbyterian Brooklyn Methodist Hospital
Arthur Riba (Author) - Oakwood Hospital and Medical Center
Udho Thadani (Author) - VA Medical Center
Shujahat Shah (Author) - Oklahoma Foundation for Cardiovascular Research
David Sandler (Author) - Hillcrest HealthCare System
David Bello (Author) - Orlando Regional Medical Center
Edward Mostel (Author) - Palm Beach Gardens Research Center
Rajul Patel (Author) - Phoenix Heart PLLC
Patrick Simpson (Author) - Pinehurst Medical Clinic Inc
Terrence Hack (Author) - Primary Care Cardiology Research
Charles Shoultz (Author) - Providence Health Center
Romel Figueredo (Author) - Reliable Clinical Research
Mahmoud Atieh (Author) - Sanford Cardiology
John Herre (Author) - Sentara Cardiovascular Research Institute
Mohit Bhasin (Author) - Sentara Cardiovascular Research Institute
Andre Gauri (Author) - Spectrum Health
Charles Gottlieb (Author) - Abbington Memorial Hospital
Peter Hotvedt (Author) - St. Elizabeth Medical Center
Muqtada Chaudhry (Author) - Caritas St. Elizabeth's Medical Center, Boston
Steven Greenberg (Author) - St Francis Roslyn
W. Kevin Tsai (Author) - Trover Health System
Marcus Averbach (Author) - St Luke's Bethlehem
Benjamin Cheong (Author) - St Luke's Episcopal Houston
Suneet Mittal (Author) - St. Luke's-Roosevelt Hospital Center;Valley Hospital
James Baker (Author) - St Thomas Research Institute
Frank McGrew (Author) - Stern Cardiovascular
David Kraus (Author) - Stern Cardiovascular Foundation
Hal Skopicki (Author) - Stony Brook University
Sung Lee (Author) - Suburban Hospital
Frank Gredler (Author) - Tallahassee Research Institute Inc
Jamal Islam (Author) - Texas Tech University Health Sciences Center
Syed Mohiuddin (Author) - Department of Medicine
Miguel Valderrabano (Author) - Houston Methodist Hospital
Nadim Nasir (Author) - Houston Methodist Hospital
Daniel Anderson (Author) - University of Nebraska Medical Center
Mark Niebauer (Author) - University of Nebraska Medical Center
Pedro Colon-Hernandez (Author) - Transcatheter Medical Inc
Judith Mackall (Author) - Case Western Reserve University
Roopinder Sandhu (Author) - University of Alberta
Peter Ott (Author) - University of Arizona
Hemal Nayak (Author) - The University of Chicago
Stephanie Dunlap (Author) - University of Cincinnati
Juan Aranda (Author) - University of Florida
Steven Hsu (Author) - University of Florida
Steven Owens (Author) - University of Kansas
Vincent See (Author) - University of Maryland, College Park
Daniel Menees (Author) - University of Michigan, Ann Arbor
Greg Flaker (Author) - University of Missouri
Samir Saba (Author) - University of Pittsburgh
Michael Fong (Author) - University of Rochester
Mehmet Aktas (Author) - University of Rochester
Terrence O'Brien (Author) - Department of Veterans Affairs
Victoria Bernstein (Author) - University of British Columbia
Pablo Saavedra (Author) - Vanderbilt University
Matthew Koshy (Author) - Velella Research
Sean Whalen (Author) - Wake Forest
Zayd Eldadah (Author) - Washington Hospital Center
David Haines (Author) - William Beaumont Hospital
Kevin Marzo (Author) - Winthrop University Hospital
Additional links: Soliman, Khalid S.
Publication Details: JAMA Cardiology, Vol.3(7), pp.591-600
Series: 3
Number of pages: 10
Grant note: was supported by a research grant from the National Heart, Lung, and Blood Institute (R01HL091069) and by St Jude Medical Inc and St Jude Medical Foundation. Funding Information: completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Dr Narula reports personal fees from Quintiles Cardiac Safety Services during the conduct of the study. Dr Lee reports receiving grants from St Jude Medical and National Institutes of Health. Dr Goldberger is the director of Path to Improved Risk Stratification. Dr Albert reports receiving grants from St Jude Medical, National Insti- tutes of Health, and Roche Diagnostics outside the submitted work. No other disclosures were reported.
Identifiers: 991005929938102656
Academic Unit: General Medicine
Language: English
Resource Type: Journal article

Sudden death in patients with coronary heart disease without severe systolic dysfunction

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