Deo Rajat, Vittinghoff Eric, Lin Feng, Tseng Zian H, Hulley Stephen B, Shlipak Michael G
Section of Electrophysiology, Division of Cardiovascular Medicine, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA.
Arch Intern Med. 2011 Oct 24;171(19):1703-9. doi: 10.1001/archinternmed.2011.328. Epub 2011 Jul 25.
To our knowledge, the risk of sudden cardiac death (SCD) and the assessment of risk factors in prediction models have not been evaluated in women with coronary artery disease (CAD). We sought to evaluate the incidence of SCD as well as its risk factors and their predictive accuracy among a population of women with CAD.
The Heart and Estrogen/progestin Replacement Study evaluated the effects of hormone replacement therapy on cardiovascular events among 2763 postmenopausal women with CAD. Sudden cardiac death was defined as death resulting from a cardiac origin that occurred within 1 hour of symptom onset. The associations between candidate predictor variables and SCD were evaluated in a Cox proportional hazards model. The C-index was used to compare the predictive value of the clinical risk factors with left ventricular ejection fraction (LVEF) alone and in combination. The net reclassification improvement was also computed.
Over a mean follow-up of 6.8 years, SCD comprised 136 of the 254 cardiac deaths. The annual SCD event rate was 0.79% (95% confidence interval, 0.67-0.94). The following variables were independently associated with SCD in the multivariate model: myocardial infarction, heart failure, an estimated glomerular filtration rate of less than 40 mL/min/1.73 m(2), atrial fibrillation, physical inactivity, and diabetes. The incidences of SCD among women with 0 (n = 683), 1 (n = 1224), 2 (n = 610), and 3 plus (n = 246) risk factors at baseline were 0.3%, 0.5%, 1.2%, and 2.9% per year, respectively. The combination of clinical risk factors and LVEF (C-index, 0.681) were better predictors of SCD than LVEF alone (C-index, 0.600) and resulted in a net reclassification improvement of 0.20 (P < .001).
Sudden cardiac death comprised the majority of cardiac deaths among postmenopausal women with CAD. Independent predictors of SCD, including myocardial infarction, congestive heart failure, an estimated glomerular filtration rate of less than 40 mL/min/1.73 m(2), atrial fibrillation, physical inactivity, and diabetes, improved SCD prediction when they were considered in addition to LVEF.
据我们所知，尚未对冠心病（CAD）女性患者的心源性猝死（SCD）风险以及预测模型中的风险因素评估进行过研究。我们旨在评估CAD女性人群中SCD的发生率及其风险因素以及它们的预测准确性。
心脏与雌激素/孕激素替代研究评估了激素替代疗法对2763名绝经后CAD女性心血管事件的影响。心源性猝死定义为症状发作后1小时内由心脏原因导致的死亡。在Cox比例风险模型中评估候选预测变量与SCD之间的关联。使用C指数比较临床风险因素单独以及与左心室射血分数（LVEF）联合的预测价值。还计算了净重新分类改善情况。
在平均6.8年的随访期内，254例心脏死亡中有136例为SCD。SCD的年事件发生率为0.79%（95%置信区间，0.67 - 0.94）。多变量模型中，以下变量与SCD独立相关：心肌梗死、心力衰竭、估计肾小球滤过率低于40 mL/min/1.73 m²、心房颤动、缺乏身体活动以及糖尿病。基线时具有0个（n = 683）、1个（n = 1224）、2个（n = 610）和3个及以上（n = 246）风险因素的女性中，SCD的年发生率分别为0.3%、0.5%、1.2%和2.9%。临床风险因素与LVEF联合（C指数，0.681）比单独的LVEF（C指数，0.600）能更好地预测SCD，并且净重新分类改善为0.20（P < 0.001）。
在绝经后CAD女性中，心源性猝死占心脏死亡的大多数。SCD的独立预测因素包括心肌梗死、充血性心力衰竭、估计肾小球滤过率低于40 mL/min/1.73 m²、心房颤动、缺乏身体活动以及糖尿病，在考虑LVEF之外再考虑这些因素时可改善SCD预测。
