Kannel W B, Cupples L A, D'Agostino R B
Am Heart J. 1987 Mar;113(3):799-804. doi: 10.1016/0002-8703(87)90722-8.
Over 30 years of surveillance of 5127 subjects free of CHD, 760 men and 574 women developed overt CHD, and there were 160 sudden deaths in men and 73 in women. Among those who sustained clinically manifest CHD, the sudden death risk was increased 6.7 times that of those without an interim event. Although the relative risk was comparable in the two sexes, CHD did not eliminate the female advantage over men. Myocardial infarction imposed a greater sudden death risk than angina pectoris, and silent infarctions were as dangerous as symptomatic infarctions. Onset of CHD put young and old at equal risk of sudden death. Some 40% of sudden deaths occurred in the 4% of the general population with overt CHD. The proportion of coronary attacks presenting as sudden death increased from 13% at ages 35 to 64 years to 20% at ages 65 to 94 years. The fraction of CHD deaths classified as sudden deaths was lower in those with than without interim CHD. In those with established CHD, factors reflecting ischemic myocardial damage and cardiac failure were the chief predictors of sudden death. The proportion of CHD deaths presenting as sudden deaths has not declined in subjects with prior CHD over three decades, despite a national decline in the overall CHD mortality rate.
在对5127名无冠心病受试者长达30多年的监测中，760名男性和574名女性患上了显性冠心病，男性中有160例猝死，女性中有73例猝死。在那些患有临床显性冠心病的人中，猝死风险比没有中间事件的人增加了6.7倍。尽管两性的相对风险相当，但冠心病并没有消除女性相对于男性的优势。心肌梗死比心绞痛带来的猝死风险更大，无症状梗死与有症状梗死一样危险。冠心病的发作使年轻人和老年人面临同等的猝死风险。约40%的猝死发生在4%患有显性冠心病的普通人群中。冠心病发作表现为猝死的比例从35至64岁年龄段的13%增加到65至94岁年龄段的20%。被归类为猝死的冠心病死亡比例在有中间冠心病的人群中低于没有中间冠心病的人群。在已确诊冠心病的人群中，反映缺血性心肌损伤和心力衰竭的因素是猝死的主要预测指标。尽管全国冠心病总体死亡率有所下降，但在过去三十年中，有既往冠心病的受试者中冠心病发作表现为猝死的比例并未下降。
