Sudden Cardiac Death in Women With Suspected Ischemic Heart Disease, Preserved Ejection Fraction, and No Obstructive Coronary Artery Disease: A Report From the Women's Ischemia Syndrome Evaluation Study.

• Type of Material: Article
• Authors: Puja Mehta, Emory University; B. Delia Johnson, University of Pittsburgh; Tanya S. Kenkre, University of Pittsburgh; Wafia Eteiba, University of Pittsburgh; Barry Sharaf, Rhode Island Hospital; Carl J. Pepine, University of Florida; Steven E. Reis, University of Pittsburgh Medical Center; William J. Rogers, University of Alabama; Sheryl F. Kelsey, University of Pittsburgh; Diane V. Thompson, Allegheny General Hospital; Vera Bittner, University of Alabama; George Sopko, Allegheny General Hospital; Leslee Shaw, Emory University; C. Noel Bairey Bairey Merz, Emory University
• Language: English
• Date: 2017-08-21
• Publisher: Wiley Open Access: Creative Commons Attribution Non-Commercial
• Publication Version: Final Published Version
• Copyright Statement: © 2017 The Authors
• License: Creative Commons Attribution-NonCommercial 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1161/JAHA.117.005501
• Title of Journal or Parent Work: Journal of the American Heart Association
• ISSN: 2047-9980
• Volume: 6
• Issue: 8
• Grant/Funding Information: This work was supported by contracts from the National Heart, Lung, and Blood Institute's nos. N01‐HV‐68161, N01‐HV‐68162, N01‐HV‐68163, N01‐HV‐68164, grants U0164829, U01 HL649141, U01 HL649241, K23HL105787, T32HL69751, R01 HL090957, 1R03AG032631 from the National Institute on Aging, General Clinical Research Center grant MO1‐RR00425 from the National Center for Research Resources, the National Center for Advancing Translational Sciences Grant UL1TR000124, and grants from the Gustavus and Louis Pfeiffer Research Foundation, Danville, NJ, The Women's Guild of Cedars‐Sinai Medical Center, Los Angeles, CA, The Ladies Hospital Aid Society of Western Pennsylvania, Pittsburgh, PA, and Qmed Inc., Laurence Harbor, NJ, the Edythe L. Broad and the Constance Austin Women's Heart Research Fellowships, Cedars‐Sinai Medical Center, Los Angeles, California, the Barbra Streisand Women's Cardiovascular Research and Education Program, Cedars‐Sinai Medical Center, Los Angeles, the Society for Women's Health Research (SWHR), Washington, DC, The Linda Joy Pollin Women's Heart Health Program, and the Erika Glazer Women's Heart Health Project, and the Adelson Family Foundation, Cedars‐Sinai Medical Center, Los Angeles, California.; Dr Pepine was also supported by National Institutes of Health grants HL33610, HL56921; UM1 HL087366; the Gatorade Trust through funds distributed by the University of Florida, Department of Medicine; NIH NCATS—University of Florida Clinical and Translational Science UL1TR001427; and PCORnet‐OneFlorida Clinical Research Consortium Clinical Data Research Network‐1501‐26692.
• Keywords: sudden cardiac death; ischemic heart disease; coronary atherosclerosis; women
• Research Categories: Health Sciences, General

Abstract

BACKGROUND: Sudden cardiac death (SCD) is often the first presentation of ischemic heart disease; however, there is limited information on SCD among women with and without obstructive coronary artery disease (CAD). We evaluated SCD incidence in the WISE (Women's Ischemia Syndrome Evaluation) study. METHODS AND RESULTS: Overall, 904 women with suspected ischemic heart disease with preserved ejection fraction and core laboratory coronary angiography were followed for outcomes. In case of death, a death certificate and/or a physician or family narrative of the circumstances of death was obtained. A clinical events committee rated all deaths as cardiovascular or noncardiovascular and as SCD or non-SCD. In total, 96 women (11%) died over a median of 6 years (maximum: 8 years). Among 65 cardiovascular deaths, 42% were SCD. Mortality per 1000 person-hours increased linearly with CAD severity (no CAD: 5.8; minimal: 15.9; obstructive: 38.6; P<0.0001). However, the proportion of SCD was similar across CAD severity: 40%, 58%, and 38% for no, minimal, and obstructive CAD subgroups, respectively (P value not significant). In addition to traditional risk factors (age, diabetes mellitus, smoking), a history of depression (P=0.018) and longer corrected QT interval (P=0.023) were independent SCD predictors in the entire cohort. Corrected QT interval was an independent predictor of SCD in women without obstructive CAD (P=0.033). CONCLUSIONS: SCD contributes substantially to mortality in women with and without obstructive CAD. Corrected QT interval is the single independent SCD risk factor in women without obstructive CAD. In addition to management of traditional risk factors, these data indicate that further investigation should address mechanistic understanding and interventions targeting depression and corrected QT interval in women.