Background Coronary artery disease is the most common condition associated with sudden cardiac death. However, the determinants of sudden cardiac death (SCD) among patients with coronary artery disease remain poorly defined.
Methods The Oregon Sudden Unexpected Death Study (Ore-SUDS) is a prospective, multiple-source population-based study of SCD among all residents of Multnomah County OR (pop. 660,486). We evaluated severity and regional distribution of coronary artery lesions in consecutively ascertained adult cases of SCD that underwent coronary angiograms prior to death. Comparisons were conducted with a geographically matched control group of patients with coronary artery disease and no history of SCD, also using findings from coronary angiography. All patients were required to have significant coronary artery disease (> 50% stenosis in at least one major coronary artery).
Results Mean age of SCD cases (n = 88) and controls (n = 195) was 66.1 yrs (30.6% female) and 65.0 yrs (32.8% female; age p = .48 and gender p = .71), respectively. Overall there was no statistically significant difference between severity of coronary artery disease when comparing the cases and controls. There were a similar number of cases and controls who had 1-, 2-, or 3-vessel disease. Furthermore, the distribution of lesions was very similar when comparing the cases and controls. Lastly, over 90% of both the cases and controls had at least 1 artery that had a lesion that resulted in at least a 70% obstruction of the vessel. This is true when both comparing the native and the grafted vessels of the individual cases and controls.
Conclusions When compared to controls, SCD cases were not distinguishable by either coronary artery lesion severity or regional distribution of coronary stenoses/occlusions. Determinants of sudden cardiac death in subjects with coronary artery disease may have to be sought by a detailed and comprehensive evaluation of potential genetic and environmental factors.
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