April 20, 2016 – The study appears in the first issue of the journal JAMA Cardiology.
Patients with non–ST-segment elevation acute coronary syndrome (NSTE ACS) are at varying degrees of risk for sudden cardiac death (SCD). Risk-stratification tools can be useful in identifying NSTE ACS patients who are at particularly high risk.
That is the finding of a study published in the inaugural issue of JAMA Cardiology, a new cardiovascular journal. The study was conducted by the DCRI’s Daniel M. Wojdyla, MS; Sana M. Al-Khatib, MD, MHS; Yuliya Lokhnygina, PhD; Matthew T. Roe, MD, MHS; E. Magnus Ohman, MD; John H. Alexander, MD, MHS; Jonathan P. Piccini, MD, MHS; Pierluigi Tricoci, MD, PhD, MHS, (pictured) and colleagues from other institutions.
Although medical advances have lowered the overall number of coronary heart disease-related deaths in recent decades, rates of sudden cardiac death have remained largely unchanged. The first step to managing care and preventing SCD for these patients is understanding the relative risk for each one.
To better understand how to gauge the risk of SCD in NSTE ACS patients, the researchers analyzed data from four randomized clinical trials that enrolled such patients: the Study of Platelet Inhibition and Patient Outcomes (PLATO), Apixaban for Prevention of Acute Ischemic Events 2 (APPRAISE-2),Thrombin Receptor Antagonist for Clinical Event Reduction in Acute Coronary Syndrome (TRACER), and Targeted Platelet Inhibition to Clarify the Optimal Strategy to Medically Manage Acute Coronary Syndromes (TRILOGY ACS).
In this study, the researchers examined the cumulative incidence of SCD and cardiovascular death according to time after NSTE ACS among patients in these four studies. In total, they analyzed data from more than 37,500 patients.
Their analysis revealed that among 37,555 patients, 2,109 deaths occurred after a median follow-up of 12.1 months. Of these deaths, 1,640 were classified as cardiovascular; of the cardiovascular deaths, 513 (31.3 percent) were classified as sudden. The researchers also identified several factors associated with an increased risk of SCD: reduced left ventricular ejection fraction (LVEF), older age, diabetes mellitus, lower creatinine clearance, higher heart rate, prior myocardial infarction, peripheral artery disease, Asian race, and male sex.
Conditions and events that happened after the initial presentation with ACS, in particular recurrent heart attack and rehospitalization, were also associated with the risk of subsequent SCD.
These findings could be useful in constructing a risk stratification tool for NSTE ACS patients, the researchers concluded. Such a tool would be helpful for both research and clinical care purposes.