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Risk Stratification for Sudden Death in Patients with Coronary Artery Disease

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Electrical Diseases of the Heart

Abstract

Approximately one-half of all deaths in patients with coronary artery disease occur suddenly and unexpectedly. The majority of these events appear to result from ventricular tachycardia or fibrillation. Although acute ischemia or infarction may precipitate such events, data suggest that a large proportion of these are not due to acute ischemic events. Rather, primary electrical phenomena that are a consequence of previous myocardial infarctions, such as intramyocardial reentry or other mechanisms, cause most of these events. These events usually occur without any apparent precipitating factor. While we have effective treatment for survivors of cardiac arrest, a minority of arrest victims survive the acute event. Thus, there is a need to identify patients at risk for these events before they occur, in order to institute prophylactic therapy.

Multiple tests to identify persons at risk for sudden death have been developed. No single test has been identified that has adequate sensitivity and specificity, when used by itself, because no test identifies patients at risk for all the various mechanisms that can cause sudden death. Increasing evidence suggests that the presence of multiple risk factors in an individual identifies persons at increased risk, while patients with only single risk factors, regardless of the specific factor, are at relatively low risk. However, at this time, the optimal combination of risk factors is not known. Also unknown is the optimal time for initial and repeat testing. Because of the progressive nature of coronary artery disease, tests will have to be repeated at intervals in patients with initial negative tests. Clinical trials are needed to define the best timing and combinations of tests.

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Authors and Affiliations

  1. Cardiovascular Division, Medicine Department, Beth Israel Deaconess Medical Center, Harvard Medical School, West – Baker 4, 185 Pilgrim Road, Boston, MA, 02215, USA

    Emerson H. Liu MD

  2. Department of Cardiology, Wentworth-Douglass Hospital, Dover, NH, USA

    Lilian P. Joventino MD

  3. Clinical Electrophysiology Laboratory, Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, West – Baker 4, 185 Pilgrim Road, Boston, MA, 02215, USA

    Alfred E. Buxton MD

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  1. Emerson H. Liu MD
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  2. Lilian P. Joventino MD
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  3. Alfred E. Buxton MD
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Correspondence to Alfred E. Buxton MD .

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  1. , Department of Internal Medicine, UMDNJ-RWJ Medical School, Robert Wood Johnson Pl. 1, New Brunswick, 08903-0019, New Jersey, USA

    Ihor Gussak

  2. , Gordon K. Moe Scholar, Masonic Medical Research Laboratory, Bleecker Street, Utica, 13501-1787, New York, USA

    Charles Antzelevitch

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Liu, E.H., Joventino, L.P., Buxton, A.E. (2013). Risk Stratification for Sudden Death in Patients with Coronary Artery Disease. In: Gussak, I., Antzelevitch, C. (eds) Electrical Diseases of the Heart. Springer, London. https://doi.org/10.1007/978-1-4471-4978-1_22

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