USE OF EVIDENCE-BASED MEDICATIONS FOR CORONARY ARTERY DISEASE AND DIABETES IN WOMEN AND MEN WITH OUT OF HOSPITAL SUDDEN UNEXPECTED DEATH IN THE SUDDEN UNEXPECTED DEATH IN NORTH CAROLINA (SUDDEN) STUDY

Background: Despite guidelines recommendations for early invasive management in non-ST-elevation myocardial infarction (NSTEMI), some patients (pts) with significant coronary artery disease (CAD) found on early angiography do not undergo revascularization. The prevalence, clinical features, and long-term prognosis of this population have not been well-characterized. Methods: We evaluated 8225 NSTEMI pts from the SYNERGY trial (2002–2004) with >50% stenosis in at least 1 epicardial artery who received in-hospital percutaneous coronary intervention (PCI), in-hospital coronary artery bypass grafting (CABG), or no revascularization before discharge (medical management). A propensity-adjusted Cox proportional hazards model was used to compare death/MI rates at 6 months and mortality rates at 1 year among the 3 subgroups starting from the time of hospital discharge. Results: A total of 2633 of 8255 pts (32%) were medically managed, 4294 (52%) underwent PCI, and 1298 (16%) underwent CABG. Clinical features and unadjusted outcomes are shown below. Guidelines-recommended discharge medications were used in a large proportion of patients, but those undergoing PCI most commonly received evidence-based therapies. The adjusted risk of 6-month death or MI was 2.19 (95% CI: 1.79–2.67) for medical management compared with PCI, and 3.07 (95% CI: 2.18 – 4.34) for medical management compared with CABG. The adjusted risks of 1-year mortality for medical management were 1.52 (95% CI: 1.07–2.17) and 1.70 (95% CI: 0.96–3.03), respectively. Conclusion: A substantial proportion of NSTEMI pts with significant CAD are managed medically without in-hospital revascularization. These pts have higher-risk clinical characteristics and worse outcomes compared with those who undergo PCI or CABG, despite fairly good use of evidence-based medications. Therefore, innovative treatment strategies are needed to mitigate the increased risk of adverse outcomes in this population. Baseline Characteristics, Discharge Medications, and Unadjusted Clinical Outcomes for the 3 Groups

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Diagnostic Algorithms in Patients with Suspected Coronary Artery Disease: Guidelines and Evidence-Based Behaviors

From Basic Cardiac Imaging to Image Fusion ◽

10.1007/978-88-470-2760-2_9 ◽

2013 ◽

pp. 125-134

Author(s):

Stefania Paolillo ◽

Pasquale Perrone Filardi

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Suspected Coronary Artery Disease ◽

Evidence Based ◽

Diagnostic Algorithms ◽

Artery Disease

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Incidence of cardiac fibrosis in SUDEP and control cases

Neurology ◽

10.1212/wnl.0000000000005740 ◽

2018 ◽

Vol 91 (1) ◽

pp. e55-e61 ◽

Cited By ~ 8

Author(s):

Orrin Devinsky ◽

Anthony Kim ◽

Daniel Friedman ◽

Annie Bedigian ◽

Ellen Moffatt ◽

...

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Cardiac Fibrosis ◽

Systematic Investigation ◽

Unexpected Death ◽

Multiple Control ◽

Cardiac Pathology ◽

Arrhythmic Death ◽

Comparison Groups ◽

Artery Disease

ObjectiveSince cardic fibrosis was previously found more frequently in patients with sudden unexpected death in epilepsy (SUDEP) than control cases, we compared blinded and quantitative reviews of cardiac pathology in SUDEP to multiple control groups.MethodsWe adjudicated causes of death in epilepsy patients as part of consecutive out-of-hospital sudden cardiac deaths (SCDs) from the Postmortem Systematic Investigation of Sudden Cardiac Death (POSTSCD) study. Blinded cardiac gross and microscopic examinations were performed by forensic and cardiac pathologists.ResultsOf 541 SCDs over 37 months (mean age 62.8 years, 69% male), 525 (97%) were autopsied; 25/525 (4.8%) had epilepsy (mean age 56.4 years ± 15.4, range 27–92; 67% male). The 25 epilepsy patients died of definite SUDEP/definite SUDEP-plus (n = 8), possible SUDEP (n = 10), or other causes (n = 7). Comparison groups included autopsy-defined sudden arrhythmic death (SAD; n = 285) and trauma (n = 104) and we adjusted for age, sex, HIV, coronary artery disease, congestive heart failure, and cardiomyopathy in the analyses. Compared to SAD cases, SUDEP cases had less gross and histologic evidence of cardiac pathology; significant for cardiac mass (p < 0.0011), coronary artery disease (p < 0.0024), total cardiac fibrosis (CF) (p = 0.022), and interstitial CF (p = 0.013). Compared to trauma cases, SUDEP cases had similar cardiac pathology including CF.ConclusionAmong SUDEP cases, cardiac pathology was less severe than in SAD cases but similar to trauma and epilepsy controls. Our data do not support prior studies finding elevated rates of CF among SUDEP cases compared to controls. Larger studies including molecular analyses would further our understanding of cardiac changes associated with SUDEP.

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