Risk of sudden cardiac arrest in patients with acute myocardial infarction or coronary artery disease: insights from SCD-PROTECT
D Duncker, E Marijon, M Metra, O Piot, M Fudim, U Siebert, N Frey, L Maier, J BauersachsAbstract
Background
The SCD-PROTECT study demonstrated a substantial risk of sudden cardiac death in patients with newly diagnosed cardiomyopathy and reduced LVEF, in the early phase regardless of etiology.
Purpose
This sub-analysis of SCD-PROTECT should provide a more detailed risk assessment in patients after myocardial infarction (MI) or with coronary artery disease (CAD).
Methods
SCD-PROTECT enrolled all patients in Germany who received a wearable cardioverter-defibrillator (WCD) between December 2021 and May 2023. Patient data were assessed during the early high-risk period before an implantable cardioverter-defibrillator (ICD) was indicated. Primary outcome was the incidence of SCA measured by appropriate WCD treatments and reported as incidence rate of first events per 100 patient years (py) as well as overall incidence density of all events. Secondary outcomes included inappropriate WCD treatments, mortality, adverse events, adherence, and use of heart failure medication.
Results
Of 19,598 patients in SCD-PROTECT, 8,149 had an ischemic cause for cardiomyopathy (acute MI: 4,860 (59.6%) and CAD: 3,289 (40.4%) patients). In the total MI/CAD population,1,329 patients (16.3%) were women (MI: 854 (17.6%); CAD: 475(14.4%)) and mean age was 64.2±10.6 years (MI: 63.3±11.0 years; CAD: 65.7±10.0 years). In all groups, women were significantly older than men (total: female 66.0±10.9 years vs. male 63.9±10.6 years, p<0.0001). The incidence rate of first appropriate WCD treatment per 100 py in the MI group was 10.91 (95%CI: 8.82-13.35) and 5.30 (95%CI: 3.60-7.52), p<0.001 in the CAD group. The overall incidence density of appropriate WCD treatments per 100 py in the MI group was 19.56 (95%CI: 16.72-22.74) and in the CAD group 8.21 (95%CI: 6.05-10.88, p<0.001). The incidence rate for the first appropriate treatment in the CAD group showed a numerically higher incidence for women (female: 9.79 (95%CI: 4.23-19.29) per 100 py; male: 4.58 (95%CI: 2.9-6.87) per 100 py, p=0.07). The only statistically significant difference between genders was observed in the overall incidence density for the CAD group (female: 15.88 (95%CI: 8.46-27.16) per 100 py; male: 6.95 (95%CI: 4.84-9.67) per 100 py, p=0.02). Inappropriate WCD treatments were observed in 32 (0.7%) patients with MI and 18 (0.5%) patients with CAD. Data on WCD usage, LVEF improvement, ICD implantation and mortality are shown in Table 1.
Conclusion
While incidences of SCA in all groups investigated were substantial, the incidence rate of first appropriate WCD treatment was twice as high in patients after acute MI compared to patients with CAD.Baseline characteristics and study results