Aro Aapo L, Rusinaru Carmen, Uy-Evanado Audrey, Reinier Kyndaron, Phan Derek, Gunson Karen, Jui Jonathan, Chugh Sumeet S
Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland.
Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Int J Cardiol. 2017 Mar 15;231:26-30. doi: 10.1016/j.ijcard.2016.12.021. Epub 2016 Dec 12.
Syncope has been associated with increased risk of sudden cardiac arrest (SCA) in specific patient populations, such as hypertrophic cardiomyopathy, heart failure, and long QT syndrome, but data are lacking on the risk of SCA associated with syncope among patients with coronary artery disease (CAD), the most common cause of SCA. We investigated this association among CAD patients in the community.
All cases of SCA due to CAD were prospectively identified in Portland, Oregon (population approximately 1 million) as part of the Oregon Sudden Unexpected Death Study 2002-2015, and compared to geographical controls. Detailed clinical information including history of syncope and cardiac investigations was obtained from medical records.
2119 SCA cases (68.4±13.8years, 66.9% male) and 746 controls (66.7±11.7years, 67.0% male) were included in the analysis. 143 (6.8%) of cases had documented syncope prior to the SCA. SCA cases with syncope were >5years older and had more comorbidities than other SCA cases. After adjusting for clinical factors and left ventricular ejection fraction (LVEF), syncope was associated with increased risk of SCA (OR 2.8; 95%CI 1.68-4.85). When analysis was restricted to subjects with LVEF ≥50%, the risk of SCA associated with syncope remained significantly elevated (adjusted OR 3.1; 95%CI 1.68-5.79).
Syncope was associated with increased risk of SCA in CAD patients even with preserved LV function. These findings suggest a role for this clinical marker among patients with CAD and normal LVEF, a large sub-group without any current means of SCA risk stratification.
晕厥与特定患者群体（如肥厚型心肌病、心力衰竭和长QT综合征）的心脏性猝死（SCA）风险增加有关，但对于冠状动脉疾病（CAD，SCA最常见的病因）患者中与晕厥相关的SCA风险，相关数据尚缺乏。我们在社区CAD患者中调查了这种关联。
作为2002 - 2015年俄勒冈州意外猝死研究的一部分，在俄勒冈州波特兰市（人口约100万）前瞻性地识别出所有因CAD导致的SCA病例，并与地理对照进行比较。从医疗记录中获取包括晕厥病史和心脏检查在内的详细临床信息。
分析纳入了2119例SCA病例（68.4±13.8岁，66.9%为男性）和746例对照（66.7±11.7岁，67.0%为男性）。143例（6.8%）病例在SCA之前有记录的晕厥。有晕厥的SCA病例比其他SCA病例年龄大5岁以上且合并症更多。在调整临床因素和左心室射血分数（LVEF）后，晕厥与SCA风险增加相关（OR 2.8；95%CI 1.68 - 4.85）。当分析仅限于LVEF≥50%的受试者时，与晕厥相关的SCA风险仍显著升高（调整后OR 3.1；95%CI 1.68 - 5.79）。
即使左心室功能保留，晕厥在CAD患者中也与SCA风险增加相关。这些发现表明该临床标志物在CAD和LVEF正常的患者（这是一个目前没有任何SCA风险分层方法的大亚组）中具有一定作用。
