Sudden Cardiac Death in the Young

Background: Sudden cardiac death (SCD) in the young is devastating. Contemporary incidence remains unclear with few recent nationwide studies and limited data addressing risk factors for causes. We aimed to determine incidence, trends, causes, and risk factors for SCD in the young. Methods and Results: The National Coronial Information System registry was reviewed for SCD in people aged 1 to 35 years from 2000 to 2016 in Australia. Subjects were identified by the International Classification of Diseases , Tenth Revision code relating to circulatory system diseases (I00–I99) from coronial reports. Baseline demographics, circumstances, and cause of SCD were obtained from coronial and police reports, alongside autopsy and toxicology analyses where available. During the study period, 2006 cases were identified (median age, 28±7 years; men, 75%; mean body mass index, 29±8 kg/m 2 ). Annual incidence ranged from 0.91 to 1.48 per 100 000 age-specific person-years, which was the lowest in 2013 to 2015 compared with previous 3-year intervals on Poisson regression model ( P =0.001). SCD incidence was higher in nonmetropolitan versus metropolitan areas (0.99 versus 0.53 per 100 000 person-years; P <0.001). The most common cause of SCD was coronary artery disease (40%), followed by sudden arrhythmic death syndrome (14%). Incidence of coronary artery disease–related SCD decreased from 2001–2003 to 2013–2015 ( P <0.001). Proportion of SCD related to sudden arrhythmic death syndrome increased during the study period ( P =0.02) although overall incidence was stable ( P =0.22). Residential remoteness was associated with coronary artery disease–related SCD (odds ratio, 1.44 [95% CI, 1.24–1.67]; P <0.001). For every 1-unit increase, body mass index was associated with increased likelihood of SCD from cardiomegaly (odds ratio, 1.08 [95% CI, 1.05–1.11]; P <0.001) and dilated cardiomyopathy (odds ratio, 1.04 [95% CI, 1.01–1.06]; P =0.005). Conclusions: Incidence of SCD in the young and specifically coronary artery disease–related SCD has declined in recent years. Proportion of SCD related to sudden arrhythmic death syndrome increased over the study period. Geographic remoteness and obesity are risk factors for specific causes of SCD in the young.

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Obesity and sudden cardiac death in the young: Clinical and pathological insights from a large national registry

European Journal of Preventive Cardiology ◽

10.1177/2047487317751291 ◽

2018 ◽

Vol 25 (4) ◽

pp. 395-401 ◽

Cited By ~ 16

Author(s):

Gherardo Finocchiaro ◽

Michael Papadakis ◽

Harshil Dhutia ◽

Della Cole ◽

Elijah R Behr ◽

...

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Sudden Cardiac Death ◽

Left Ventricular Hypertrophy ◽

Cardiac Death ◽

Ventricular Hypertrophy ◽

Left Ventricular ◽

Arrhythmic Death ◽

Sudden Arrhythmic Death Syndrome ◽

Artery Disease

Aims Obesity is an increasing public health problem and a risk factor for cardiovascular diseases. The aim of the study was to determine the main features and aetiologies in a large cohort of sudden cardiac deaths that occurred in obese subjects. Methods Between 1994 and 2014, 3684 consecutive cases of unexpected sudden cardiac death were referred to our cardiac pathology centre. This study was confined to young individuals (age ≤ 35 years) for whom information about body mass index was available and consisted of 1033 cases. Results Two-hundred and twelve individuals (20%) were obese. In obese sudden cardiac death victims the main post-mortem findings were: normal heart (sudden arrhythmic death syndrome) ( n = 108; 50%), unexplained left ventricular hypertrophy ( n = 25; 12%) and critical coronary artery disease ( n = 25; 12%). Less common were hypertrophic cardiomyopathy ( n = 4; 2%) and arrhythmogenic right ventricular cardiomyopathy ( n = 4;2%). When compared with non-obese sudden cardiac death victims, sudden arrhythmic death syndrome was less common (50% vs. 60%, P < 0.01), whereas left ventricular hypertrophy and critical coronary artery disease were more frequent (12% vs. 2%, P < 0.001 and 12% vs. 3%, P < 0.001, respectively). The prevalence of critical and non-critical coronary artery disease was significantly higher in obese individuals (23% vs. 10% in non-obese individuals, P < 0.001). Conclusions Various conditions underlie sudden cardiac death in obesity, with a prevalence of sudden arrhythmic death syndrome, left ventricular hypertrophy and coronary artery disease. The degree of left ventricular hypertrophy measured by heart weight is excessive even after correction for body size. Almost one in four young obese sudden death patients show some degree of coronary artery disease, underscoring the need for primary prevention in this particular subgroup.

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Severity of coronary artery disease, cardiac hypertrophy and coronary risk factors in victims of sudden cardiac death caused by an acute coronary event

International Journal of Cardiology ◽

10.1016/j.ijcard.2007.03.017 ◽

2007 ◽

Vol 119 ◽

pp. S6

Author(s):

Kari Kaikkonen ◽

Marja-Leena Kortelainen ◽

Heikki Huikuri

Keyword(s):

Risk Factors ◽

Coronary Artery Disease ◽

Coronary Artery ◽

Sudden Cardiac Death ◽

Cardiac Death ◽

Coronary Event ◽

Coronary Risk Factors ◽

Coronary Risk ◽

Acute Coronary Event ◽

Artery Disease

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Perioperative ischaemia and management of patients with coronary stents: current practice

Journal of Society of Anesthesiologists of Nepal ◽

10.3126/jsan.v1i1.13588 ◽

2015 ◽

Vol 1 (1) ◽

pp. 40-48

Author(s):

Jeju Nath Pokharel

Keyword(s):

Risk Factors ◽

Myocardial Infarction ◽

Coronary Artery Disease ◽

Coronary Artery ◽

Sudden Cardiac Death ◽

Cardiac Death ◽

Coronary Thrombosis ◽

Perioperative Period ◽

Coronary Stents ◽

Artery Disease

Perioperative ischaemia is a common cause of cardiac morbidity and cardiac death during perioperative period in patient with coronary artery disease or with other risk factors. The incidence of perioperative ischaemia is about 20 to 70% in patient with coronary artery disease or coronary artery disease risk factors. Post operative cardiac events (the combined incidence of nonfatal myocardial infarction, unstable angina, heart failure and sudden cardiac death) vary between 5.5 to 53% and postoperative myocardial infarction varies between 1.4 to 43%. Prolonged ST- segment depression along with hypercoagulability caused by surgical stress, platelet activation, increased fibrinogen activity and decreased fibrinolytic activities may lead to coronary thrombosis, ischaemia, nonfatal infarction or sudden cardiac death. Patients with coronary stents especially before complete endothelialization of the stents are of high risk category for these complications. Anesthesiologist being a perioperative physician should understand safety issues of these patients to prevent from ischaemia, coronary thrombosis and subsequent infarction or sudden cardiac death. Risk identification, optimization, monitoring, diagnosis of the problem, prevention and management are very crucial during perioperative period to enhance the quality service and patient safety.Journal of Society of Anesthesiologists 2014 1(1): 40-48

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Risk stratification for sudden cardiac death in the general population

ESC CardioMed ◽

10.1093/med/9780198784906.003.0544 ◽

2018 ◽

pp. 2305-2308

Author(s):

Efstathios K. Iliodromitis ◽

Dimitrios Farmakis

Keyword(s):

Risk Factors ◽

Coronary Artery Disease ◽

Heart Disease ◽

Coronary Artery ◽

Sudden Cardiac Death ◽

General Population ◽

Risk Stratification ◽

Cardiac Death ◽

Increased Risk ◽

Artery Disease

There are three main groups in the general population as far as sudden cardiac death (SCD) is concerned: individuals without a known history or predisposing factors for heart disease; individuals with known risk factors for heart disease or SCD; and patients with diagnosed ischaemic, structural, or electrical cardiac conditions, acquired or genetic, that are associated with an increased risk for SCD. Although SCD literature focuses mainly on patients with known heart disease, approximately 50% of SCD cases occur in individuals belonging to the first two groups. The annual incidence of SCD in the general population ranges between 0.6 and greater than 1.4 per 1000 individuals. SCD occurs more commonly in men than in women and with an incidence that increases with age due to the increase in coronary artery disease. The commonest aetiologies for SCD in the general population are coronary artery disease and cardiomyopathy, accounting for 80% and 10–15% of cases, respectively. A number of factors have been related to an increased risk for SCD in the general population including genetic predisposition, risk factors for atherosclerosis, strenuous physical activity and sports, electrocardiographic abnormalities, elevated levels of biomarkers, and abnormalities in imaging and other diagnostic techniques. However, large-scale prospective studies that confirm the feasibility, clinical efficacy, and cost-effectiveness of using these factors for broad mass screening for SCD are generally lacking and therefore risk stratification for SCD in the general population remains challenging.

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Current Smoking, Smoking Cessation, and the Risk of Sudden Cardiac Death in Patients With Coronary Artery Disease

Archives of Internal Medicine ◽

10.1001/archinte.163.19.2301 ◽

2003 ◽

Vol 163 (19) ◽

pp. 2301 ◽

Cited By ~ 104

Author(s):

Ilan Goldenberg

Keyword(s):

Coronary Artery Disease ◽

Smoking Cessation ◽

Coronary Artery ◽

Sudden Cardiac Death ◽

Cardiac Death ◽

Current Smoking ◽

Artery Disease

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Sudden Cardiac Death in Women With Suspected Ischemic Heart Disease, Preserved Ejection Fraction, and No Obstructive Coronary Artery Disease: A Report From the Women's Ischemia Syndrome Evaluation Study

Journal of the American Heart Association ◽

10.1161/jaha.117.005501 ◽

2017 ◽

Vol 6 (8) ◽

Cited By ~ 10

Author(s):

Puja K. Mehta ◽

B. Delia Johnson ◽

Tanya S. Kenkre ◽

Wafia Eteiba ◽

Barry Sharaf ◽

...

Keyword(s):

Coronary Artery Disease ◽

Heart Disease ◽

Coronary Artery ◽

Sudden Cardiac Death ◽

Ejection Fraction ◽

Cardiac Death ◽

Obstructive Coronary Artery Disease ◽

Evaluation Study ◽

Preserved Ejection Fraction ◽

Artery Disease

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P5647Temporal variability of T-wave morphology and risk of sudden cardiac death in patients with coronary artery disease

European Heart Journal ◽

10.1093/eurheartj/ehz746.0590 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

J T Rahola ◽

A M Kiviniemi ◽

O H Ukkola ◽

M P Tulppo ◽

M J Junttila ◽

...

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Sudden Cardiac Death ◽

Spatial Heterogeneity ◽

Temporal Variability ◽

Cardiac Death ◽

T Wave ◽

Clinical Risk ◽

Wave Morphology ◽

Artery Disease

Abstract Background The possible relationship between temporal variability of electrocardiographic spatial heterogeneity of repolarisation and the risk of sudden cardiac death (SCD) in patients with coronary artery disease (CAD) is not completely understood. Purpose To investigate the prognostic value of temporal variability of T-wave spatial heterogeneity in SCD in patients with CAD. Methods The Innovation to reduce Cardiovascular Complications of Diabetes at the Intersection (ARTEMIS) study population consisted of 1,946 patients with angiographically verified CAD. T-wave morphology dispersion (TMD), which estimates the average angle between all reconstruction vector pairs in T-wave loop based on leads I-II and V2-V6, was analysed on beat-to-beat basis from 10 minutes period of the baseline electrocardiographic recording in 1,678 study subjects. The temporal variability of TMD was evaluated by standard deviation of TMD (TMD-SD). Results After on average of 7.4±2.0 years of follow-up, a total of 47 of the 1,678 study subjects (2.8%) had experienced SCD or were resuscitated from sudden cardiac arrest (SCA). TMD-SD was significantly higher in patients who had experienced SCD/SCA compared with those who remained alive (3.64±2.57 vs. 2.65±2.54, p<0.01, respectively), but did not differ significantly between the patients who had experienced non-sudden cardiac death (n=40, 2.4%) and those who remained alive (2.98±2.43 vs. 2.67±2.55, p=0.45, respectively) or between the patients who succumbed to non-cardiac death (n=88, 5,2%) and those who stayed alive (2.74±2.44 vs. 2.67±2.55, p=0.81). After adjustments with relevant clinical risk indicators of SCD/SCA, such as left ventricular ejection fraction, diabetes, left bundle branch block and Canadian Cardiac Society class, TMD-SD still predicted SCD/SCA (HR 1.113, 95% CIs 1.028–1.206, p<0.01). The discrimination and reclassification accuracy increased significantly (p=0.02, p=0.033) and the C-index increased from 0.733 to 0.741 when TMD-SD was added to the clinical risk model of SCD/SCA. The Kaplan-Meier survival curves show proportional probabilities of event-free survival for different modes of death for patients classified according to the optimised TMD-SD cut-off point (Figure). Figure 1 Conclusions Temporal variability of electrocardiographic spatial heterogeneity of repolarisation represented by TMD-SD independently predicts long-term risk of SCD/SCA in patients with CAD. Acknowledgement/Funding Sigrid Juselius Foundation and Finnish Foundation for Cardiovascular Research

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Waist-to-Height Ratio (WHtR) in Predicting Coronary Artery Disease Compared to Body Mass Index and Waist Circumference in a Single Center from Saudi Arabia

Cardiology Research and Practice ◽

10.1155/2020/4250793 ◽

2020 ◽

Vol 2020 ◽

pp. 1-6

Author(s):

Mostafa Q. Alshamiri ◽

Faisal Mohd A Habbab ◽

Saad Saeed AL-Qahtani ◽

Khalil Abdullah Alghalayini ◽

Omar Mohammed Al-Qattan ◽

...

Keyword(s):

Risk Factors ◽

Coronary Artery Disease ◽

Body Mass Index ◽

Coronary Artery ◽

Cardiometabolic Risk ◽

Height Ratio ◽

History Of ◽

Male Patients ◽

Waist To Height Ratio ◽

Artery Disease

This study aims to study the efficiency of the Waist-to-Height Ratio (WHtR) for determining coronary artery disease. It compares the frequency of abnormal WHtR, as a proxy for abdominal obesity, to that of body mass index (BMI) and waist circumference (WC). It also relates the findings to other cardiometabolic risk factors in University Hospital patients. A cross-sectional study design was used, where a sample of 200 patients (142 males and 58 females) who attended the adult cardiac clinic were purposively included. BMI, WC, and WHtR were measured, where frequencies of WHtR were compared to those of BMI and WC. The findings were related to the history of coronary artery disease (CAD) and history of cardiometabolic risk factors, including diabetes mellitus (DM), hypertension (HTN), and hyperlipidemia. Majority of the male patients were older, taller, and had a lower BMI value. It also showed that the prevalence of dyslipidemia and CAD was higher in male patients. No significant difference between both genders was noticed for weight, WC, WHtR, hypertension, or DM. BMI was least associated with high-risk cardiac population in both males and females (39.4% and 60.3%), followed by WC (84.5% and 96.6%, respectively). WHtR showed the highest association with gender (male 98.6% and females 98.3%). These findings were noticed in patients with all risk factors. WHtR is superior to BMI and WC for determining the elevated risk of diabetes, hypertension, dyslipidemia, and CAD in a single university institute. The role of WHtR in both normal and diseased Saudi population should be delineated.

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Unique and Varied Contributions of Traditional CVD Risk Factors: A Systematic Literature Review of CAD Risk Factors in China

Clinical Medicine Insights Cardiology ◽

10.4137/cmc.s10225 ◽

2013 ◽

Vol 7 ◽

pp. CMC.S10225 ◽

Cited By ~ 9

Author(s):

Joanne Foody ◽

Yong Huo ◽

Linong Ji ◽

Dong Zhao ◽

Dylan Boyd ◽

...

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Coronary Artery Disease ◽

Coronary Artery ◽

Real World ◽

Odds Ratio ◽

Lipid Levels ◽

Artery Disease ◽

The Impact ◽

Cad Risk

This study is the first systematic review of risk factors for stroke in China and supports the importance of current public health initiatives to manage the risk factors appropriately to reduce risk of stroke in high risk patients. Additionally, this study has been co-authored by prominent Chinese and US physicians and researchers with expertise in cardiovascular disease, neurologic disorders, epidemiology, and real world data. While there have been several systematic reviews of real world associations of risk factors for coronary artery disease, none focus specifically on the population of China, where there is growing evidence that such risk factors are poorly treated or uncontrolled, especially in rural areas. Background To better understand the impact of traditional cardiovascular risk factors on risk of coronary artery disease (CAD) in China, a systematic review of all Chinese observational studies published in either English or Chinese in MEDLINE and EMBASE over the last 5 years was performed and the association between any of 5 traditional risk factors (ie, hypertension, diabetes, elevated lipid levels, obesity, and smoking) and the risk of CAD was studied. Methods and Results The study found a consistent relationship between lipid levels and CAD. Higher low-density lipoprotein cholesterol values were associated with greater risk of CAD, with an odds ratio as high as 3.31. Other factors found to be significant contributors to the risk of CAD included hypertension (crude odds ratio range of 1.40-5.11), diabetes (1.50-5.97), and smoking (1.37-5.19). An association between obesity and CAD in China was observed, but the evidence supporting this was considered weak due to the paucity of studies found as part of this review. Conclusions This review provides a systematic summary of CAD risk factors in China and demonstrates the important differences that exist in CAD risk factors between countries and regions. Approaches to reduce CAD globally must take into account the unique risk factors that drive CAD in each country and region as is demonstrated by these findings.

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