We prospectively evaluated the relationship of specific coronary arterial and left ventricular segments to subsequent clinical outcome in 80 persons who were survivors of sudden cardiac death and had failed conventional antiarrhythmic therapy. There were 68 men and 12 women with an average age of 51 years who were treated with investigational antiarrhythmic agents, randered asymptomatic, and followed for 16 ± 14 (SD) months. At the end of the study 48 patients (60%) were alive and asymptomatic while 32 (40%) had experienced either recurrent syncope (five) or sudden cardiac death (27). The independent relationship of clinical and angiographic variables was performed in a univariate fashion using a Kaplan-Meier survival analysis and then multivariate logistic analysis was used to simultaneously consider all clinical and arteriographic variables. The results reconfirmed the importance of ejection fraction and left ventricular filling pressure on outcome. However, coronary arterial and left ventricular segmental analyses provided additional predictive power. Specifically, the survival outcome was found to be inversely related to the degree of proximal left anterior coronary (LAD) arterial narrowing: at 1 year 90% of patients with minimal LAD narrowing were alive/asymptomatic in contrast with 70% who had partial and 40% who had complete proximal LAD obstruction (p < 0.005). Analysis of the posterobasal left ventricular segment wall motion demonstrated that 100% of patients with minimal dysfunction were alive/asymptomatic at 1 year, whereas only 52% of patients with severe dysfunction were alive (p < 0.001). A multivariate analysis using both LAD narrowing and posterobasal dysfunction correctly predicted 39 of 43 patients (91%) who were alive and 11 of 15 patients (73%) who were dead/syncopal, for a predictive accuracy of 86%. These results suggest that specific segmental cardiac lesions may accurately identify subsets of sudden cardiac death survivors who are at either exceptionally high or low risk for subsequent arrhythmic events. Application of this approach to patient management may permit improvements in the individual risk-benefit ratio of therapy.
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine