Higher coronary artery calcium burden predicts sudden cardia
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Despite significant advancements in the management of subclinical CHD in primary prevention patients, the prediction of sudden cardiac death remains “elusive”. Sudden cardiac death risk stratification can be useful in the initial stages of CHD through the measurement of CAC, identifying patients most likely to benefit from further downstream testing.

The researchers assessed the association between CAC and sudden cardiac death among 66,636 primary prevention patients from the CAC Consortium, a multi-center study that includes four high-volume centres in the U.S. The mean age of patients was 54 years, 33% were women and 89% were white. All patients were referred to undergo CAC screening (1991-2010) due to the presence of underlying ASCVD risk factors and uncertainty in long-term ASCVD risk.

Within the cohort, 55% of patients had a CAC greater than zero. More than half of patients had a 10-year ASCVD risk of less than 5%, although hypertension (31%), dyslipidemia (54.4%), and a family history of CHD (46.1%) were prevalent among study participants. Researchers observed 211 sudden cardiac death events (0.3%) during a median of 10.6 years of follow-up, with 91% of those occurring among those with baseline CAC greater than zero.

Sudden cardiac death risk stratification may be most useful in the early stages of CHD through the quantification of calcified atherosclerotic plaque burden.

Source: https://www.jacc.org/doi/10.1016/j.jcmg.2022.02.011