Prevention of Sudden Death: Selection of Patients at Risk
Prevention of sudden death requires identification of patients at risk, elucidation of the pathophysiology of the lethal event, and definition of appropriate therapy. As yet, achievement of these three goals is incomplete. Patients generally do not undergo currently available testing procedures (which are at best not totally predictive) until potential risk is heralded by some clinical event. Thus, patients with clinically silent or asymptomatic electrical instability or with coronary artery/ischemic heart disease without angina pectoris may not enter the health care system before an episode of sudden death. Moreover, even if descriptors of risk are noted prospectively, the pathophysiology of sudden lethal events is incompletely understood. The nature and clinical importance of subcellular biochemical abnormalities leading to cardiac electrical instability largely are unknown, and the relationship between chronic, irreversible electrical instability and active ischemia in patients with coronary artery disease remains unclear. Finally, even when risk and likely mechanism of death both are identified in an individual patient, current pharmacological and surgical therapies offer incomplete protection against the lethal event.
KeywordsDepression Ischemia Radionuclide Luminal Cardiomyopathy
Unable to display preview. Download preview PDF.
- 2.P. Theroux, D. D. Waters, C. Halphen, J. C. Debaisieux and H. F. Mizgala, Prognostic value of exercise testing soon after myocardial infarction, New Engl. J. Med. 301:341–345 (1979).Google Scholar
- 6.M. Sami, H. Kramer and R. F. DeBusk, The prognostic significance of serial exercise testing after myocardial infarction, Circulation 60:1238–1246 (1979).Google Scholar
- 8.K. J. Silverman, L. C. Becker, B. H. Bulkley et al., Value of early thallium - 201 scintigrapht for predicting mortality in patients with acute myocardial infarction, Circulation 61:996–1003 (1980).Google Scholar
- 9.L. C. Becker, The early post infaction patient: Identification and aggressive intervention in high risk groups; Abstract, Proceedings of Conference on Sudden Coronary Death, New York Academy of Sciences, New York, p. 33 (1981).Google Scholar
- 11.R. Shulze, J. Rouleau, P. Rigo, S. Bowers, H. W. Strauss, P,H,B, Ventricular arrhythmias in the late hospital phase of acute myocardial infarction, Circulation 52:1006–11 (1975).Google Scholar
- 13.D. H. Miller, J. S. Borer, P. D. Kligfield, D. L. Hayes and E. Whitacre, Independence of exercise-induced electrocardiographic ischemia and left ventricular function in patients with recent myocardial infarction, Clin. Research 30 (in press) (1982).Google Scholar
- 14.J. S. Borer, K. Kent, S. L. Bacharach et al., Sensitivity, specificity and predictive accuracy of radionuclide cineangiography during exercise in patients with coronary artery disease, Circulation 60:572–580 (1979).Google Scholar
- 18.C. Friedman, J. Moses, J. S. Borer, H. G. Goldberg, D. H. Miller and J. Fisher, Prognostic value of programmed ventricular stimulation early after infarction in high risk patients, Circulation (submitted).Google Scholar
- 20.J. S. Borer, S. L. Bacharach, M. V. Green, K. M. Kent, S. E. Epstein and G. S. Johnston, Real-time radionuclide cineangiography in the non-invasive evaluation of global and regional left ventricular function at rest and during exercise in patients with coronary artery disease, New Engl. J. Med. 297:839–844 (1977).Google Scholar
- 21.J. S. Borer, S. L. Bacharach, M. V. Green, K. M. Kent, G. S. Johnston and S. E. Epstein, Effect of nitroglycerin on exercise-induced abnormalities of left ventricular regional function and ejection fraction in coronary artery disease: Assessment by radionuclide cineangiography in symptomatic and asymptomatic patients, Circulation 57:314–320 (1978).Google Scholar