Coronary Artery Disease Among Survivors of VT/VF Arrest

Introduction: Current guidelines recommend coronary angiography to all survivors of sudden cardiac death (SCD) because the dominant cause is coronary artery disease (CAD). However, the need for a routine angiography among SCD survivors who do not have known heart disease, and do not have prodromal clinical symptoms, ECG changes or biomarkers suggestive of CAD is questionable. The aim of this study was to characterized the non-CAD survivors and examine the prevalence of severe CAD among these patients.

Methods: Retrospective study of survivors of out-of-hospital aborted SCD admitted from 1992 to 2015. Patients were characterized according to final major cardiac diagnosis. Coronary angiograms were reviewed.

Results: Of 1470 out-of-hospital survivors admitted to the hospital 104 (7%) had no prior known heart disease and no prodromal clinical symptoms or signs suggestive of CAD on admission. Of these, 69 (66%) had a non coronary diagnosis: 33 cardiomyopathy; 24 Valvular (severe AS or MR); 9 channelopathies, 2 metabolic disorders, 1 WPW with AF. The remaining group of 35 patients had no overt cardiac diagnosis on admission. Mean age was 54±16, and 83% males. Their echocardiography revealed preserved or mild LV dysfunction. Only 16 (45%) underwent coronary angiography, since the others had either contraindication or severe anoxic brain damage with poor prognosis. Severe CAD was found in only one (6%) patient; non obstructive lesions in 4 (25%), and normal coronaries in 11 (69%) patients.

Conclusions: In patients admitted to the hospital with aborted SCD and no overt symptoms and signs suggestive of CAD, the majority have diagnosis of other heart disease, and only a small minority was found to have CAD. These findings challenges the guidelines recommendation, and warrant a large prospective study.