Wang Shaoping, Lyu Yi, Liu Yanci, Cheng Shujuan, Li Shiying, Zheng Ze, Gu Xiaoyan, Gong Ming, Liu Jinghua, Borah Bijan J
Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, 100029 Beijing, China.
Department of Health Sciences Research, Mayo Clinic, Rochester, MN 55905, USA.
Rev Cardiovasc Med. 2023 Oct 18;24(10):294. doi: 10.31083/j.rcm2410294. eCollection 2023 Oct.
The risk of sudden cardiac death (SCD) after coronary revascularization in patients with left ventricular (LV) systolic dysfunction has not been characterized completely. This study aims to evaluate the incidence and time course of SCD after revascularization in such patients. The determinants of SCD within 3 months after revascularization were also assessed.
A cohort study of patients with reduced ejection fraction (EF 40%), who underwent revascularization was performed. The incidence of SCD was estimated to account for the competing risk of deaths due to other causes.
2317 patients were enrolled. With a median follow-up of 3.5 years, 162 (32.1%) of the 504 deaths were due to SCD. The risk of SCD was highest in the first 3 months after revascularization, with an incidence rate of 0.37%/month. The event rate decreased to 0.12%/month, 0.08%/month, 0.09%/month, 0.14%/month, and 0.19%/month at 3-6 months, 6-12 months, 1-3 years, 3-5 years, and 5-10 years, respectively. A history of ventricular tachycardia/ventricular fibrillation (hazard ratio [HR], 5.55; 95% confidence interval [CI], 1.33-23.19; = 0.019) and triple vessel disease (HR, 3.90; 95% CI, 1.38-11.05; = 0.010) were associated with the risk of SCD within 3 months. However, preoperative EF (in 5% increments) was not predictive (HR per 5% increase, 0.98; 95% CI, 0.62-1.55; = 0.935).
For patients with LV dysfunction, the risk of SCD was the highest during the first 3 months after revascularization. Further risk classification and treatment strategy are warranted.
The name of the registry: Coronary Revascularization in Patients with Ischemic Heart Failure and Prevention of Sudden Cardiac Death. Registration number: ChiCTR2100044378.
左心室（LV）收缩功能障碍患者冠状动脉血运重建后心脏性猝死（SCD）的风险尚未完全明确。本研究旨在评估此类患者血运重建后SCD的发生率及时间进程。同时还评估了血运重建后3个月内SCD的决定因素。
对射血分数降低（EF≤40%）且接受血运重建的患者进行队列研究。SCD的发生率被估计为因其他原因导致死亡的竞争风险。
共纳入2317例患者。中位随访3.5年，504例死亡患者中有162例（32.1%）死于SCD。血运重建后前3个月SCD风险最高，发生率为0.37%/月。在3 - 6个月、6 - 12个月、1 - 3年、3 - 5年和5 - 10年时，事件发生率分别降至0.12%/月、0.08%/月、0.09%/月、0.14%/月和0.19%/月。室性心动过速/心室颤动病史（风险比[HR]， 5.55；95%置信区间[CI]，1.33 - 23.19；P = 0.019）和三支血管病变（HR，3.90；95% CI，1.38 - 11.05；P = 0.010）与3个月内SCD风险相关。然而，术前EF（以5%的增量）无预测价值（每增加5%的HR，0.98；95% CI，0.62 - 1.55；P = 0.935）。
对于LV功能障碍患者，血运重建后前3个月SCD风险最高。有必要进一步进行风险分类和制定治疗策略。
注册机构名称：缺血性心力衰竭患者冠状动脉血运重建及心脏性猝死预防。注册号：ChiCTR2100044378。
