Sudden cardiac death after PCI and CABG in the bare-metal stent era: Incidence, prevalence, and predictors

Background: Few prospective cohort studies have examined the relationship between reduced left ventricular ejection fraction (LVEF) and other comorbidities for precise risk stratification of sudden cardiac death (SCD) after coronary revascularization.

Methods: We analyzed 9877 consecutive patients who underwent first elective percutaneous coronary intervention (PCI) (n=6878) and coronary artery bypass grafting (CABG) (n=2999) between 2000 and 2002 at 30 institutions registered under the CREDO-Kyoto registry.

Results: During the long-term follow-up (median follow-up period=42.8 months), 906 patients (9.4%) died; death from cardiovascular causes was observed in 517 (5.7%) patients; cardiac death, in 376 (3.9%) patients; and SCD, in 140 (1.5%) patients. The rates of SCD were 0.5%, 0.9%, and 1.3% at 1, 2, and 3 years of follow-up, respectively. Multivariate analyses indicated that dialysis (hazard ratio=2.51), chronic obstructive pulmonary disease (hazard ratio=2.04), congestive heart failure (hazard ratio=1.63), reduced LVEF (LVEF ≤ 30%; hazard ratio=1.55), chronic total occlusion of coronary artery (hazard ratio=1.38), diabetes with insulin therapy (hazard ratio=1.33), chronic renal disease (hazard ratio=1.29), and peripheral artery disease (hazard ratio=1.27) were independent predictors of SCD.

Conclusions: The method of revascularization had no influence on the incidence of SCD, and the adjusted hazard ratio of reduced LVEF was smaller than that observed in dialysis, chronic obstructive pulmonary disease, and congestive heart failure. This indicated that the risk of SCD depends on multiple variables in addition to LVEF.