DOI: 10.1161/jaha.125.049853 ISSN: 2047-9980

Dynamic Risk Trajectories for Sudden Cardiac Arrest: The Role of Recurrent Cardiovascular Events

Marita Knudsen Pope, Harpriya Chugh, Thien Tan Tri Tai Truyen, Marco Mathias, Audrey Uy‐Evanado, Honghuang Lin, Dan Atar, Nichole Bosson, Kyndaron Reinier, Emelia J. Benjamin, Sumeet S. Chugh
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Background

Although cardiovascular events increase sudden cardiac arrest (SCA) risk, the impact of recurrent events on subsequent SCA risk in a contemporary population is unknown. This study assessed whether patients with a first‐time acute coronary syndrome (ACS) or heart failure (HF) hospitalization who experience a recurrent cardiovascular event have increased SCA risk.

Methods

The OSCAR (Observational Study of Cardiac Arrest Risk) is a prospective cohort with adjudicated SCA outcomes. The current study followed up patients who survived a first ACS or HF hospitalization (the index ACS or HF cohorts) for recurrent cardiovascular events and SCA. Recurrent event was a time‐dependent variable in Cox models predicting SCA. Findings were validated in the FHS (Framingham Heart Study).

Results

Among 2946 patients in the index ACS cohort, incidence of SCA was higher following a recurrent ACS event than without (3.70 versus 1.28 per 100 patient‐years). A recurrent ACS event was associated with higher risk of SCA (adjusted hazard ratio [HR], 3.15 [95% CI, 2.06–4.83]; P <0.0001). Among 6711 patients in the index HF cohort, incidence of SCA was higher following a recurrent HF event than without (1.35 versus 0.97 per 100 patient‐years), and SCA risk was higher with recurrent HF (HR, 1.79 [95% CI, 1.44–2.23]; P <0.0001). In the FHS cohort, risk of SCA was higher with recurrent ACS (HR, 2.85 [95% CI, 1.66–4.90]; P =0.0002); the association was not significant for recurrent HF (HR, 1.49 [95% CI, 0.73–3.03]; P =0.27).

Conclusions

Recurrent events were associated with higher risk of SCA; dynamic clinical trajectories of recurrent cardiovascular events may inform prevention of SCA.

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