Suspected Fatal Arrhythmic Events in Japanese Patients With Coronary Artery Disease -- From the CREDO-Kyoto PCI/CABG Registries Cohorts-2 and -3 --

Abstract

BACKGROUND: Fatal arrhythmic events (FAEs), such as sudden cardiac death (SCD) and fatal ventricular arrhythmias, are a devastating complication in patients with coronary artery disease (CAD). Therefore, in this study we aimed to assess the incidence of FAEs in more recent Japanese patients with CAD and to examine whether risk stratification of FAEs can still be feasible using the left ventricular ejection fraction (LVEF). METHODS and RESULTS: In the CREDO Kyoto PCI/CABG registry cohorts-2 and -3, there were 25, 843 patients with LVEF data who received a first coronary revascularization (LVEF ≤35% group: N=1, 671, 35%<LVEF≤40% group: N=1, 075, 40%<LVEF≤45% group: N=1, 594, and LVEF >45%: N=21, 503). FAEs were defined as a composite of SCD or hospitalization for serious ventricular arrhythmias. The cumulative 5-year incidence of FAEs was 2.4% and it increased with decreasing LVEF (LVEF ≤35%: 8.84%, 35%<LVEF≤40%: 6.99%, 40%<LVEF≤45%: 4.49%, and LVEF >45%: 1.67%, log-rank P<0.0001). The adjusted risk of FAEs also increased with decreasing LVEF. CONCLUSIONS: LVEF is still a strong independent factor for predicting FAEs in patients with CAD in the PCI era. There was no obvious decrease in the incidence of FAEs between the 2 cohorts. The risk factors for FAEs through the 2 cohorts, other than low LVEF, included age ≥75 years, diabetes, heart failure, hemodialysis, atrial fibrillation, and anemia.