Editorial

Prevention of sudden cardiac death: Need for a plaque stabilizer

La muerte súbita probablemente sea el desafío más importante de la cardiología moderna. En este artículo, después de realizar una revisión histórica de la muerte súbita, se comentan la epidemiología y las enfermedades asociadas a ella y se hace énfasis en los aspectos fisiopatológicos, especialmente los factores desencadenantes que actuando sobre un miocardio vulnerable precipitan la arritmia final, que en general lleva a la fibrilación ventricular y en menor medida a bradiarritmia y muerte súbita. Se comentan especialmente la importancia de la isquemia aguda y la disfunción ventricular y el papel de la genética, no sólo en las cardiopatías de origen genético, sino también su posible efecto desencadenante en la cardiopatía isquémica aguda y crónica. Por último, se describe cuál es la mejor forma de identificar a los pacientes en riesgo, cómo prevenir la muerte súbita y qué conducta seguir ante un paciente resucitado de una parada cardiaca.

Sudden death is probably the greatest challenge in modern cardiology. After reviewing its history, we describe the epidemiology of sudden death and its associated diseases. We highlight its physiopathologic aspects, including the factors that act on vulnerable myocardium triggering the final arrhythmia, mainly ventricular fibrillation and, to a lesser extent, bradycardia and sudden death. We emphasize the relevance of acute ischemia, ventricular dysfunction and genetic factors, not only in genetic heart disease, but also as triggers of sudden death in acute and chronic ischemic heart disease. Finally, we describe the best way to identify candidates at risk, discuss how to prevent sudden death, and outline the best approach to managing a patient resuscitated from cardiac arrest.

Full English text available from: www.revespcardiol.org

Sudden cardiac death (SCD) remains a major public health problem; however, its true burden remains unknown with widely variable estimates of its incidence. We aimed to examine the contemporary epidemiology and autopsy characteristics of SCD in an ethnically diverse community.

Three physicians reviewed all deaths of individuals aged ≥20 years reported to the San Francisco medical examiner in 2007 for presentations fitting World Health Organization (WHO) SCD criteria—within 1 hour of symptom onset (witnessed) or within 24 hours of being observed alive and symptom free (unwitnessed). After comprehensive review of medical examiner investigation, WHO SCDs were classified as sudden arrhythmic death (SAD) or nonarrhythmic death. Coronary artery disease (CAD) and cardiac mass were evaluated in all SADs undergoing autopsy and compared with demographically similar accidental trauma control deaths.

We identified 252 WHO SCDs; 145 were SADs. Men had a 2.2-fold higher SAD rate (P < .0005). Blacks had a 3.15-fold higher SAD rate compared with whites (P = .003). Significant CAD was present in 38.9% of SADs and associated with higher SAD risk compared with control deaths (OR 2.58, 95% CI 1.12-5.97, P = .026). Mean cardiac mass was linearly associated with risk for SAD in cases without significant CAD (OR 2.06 per 100 g, 95% CI 1.43-2.98, P < .0005).

In a diverse, urban population, SAD incidence varied substantially by gender and race. Significant CAD accounted for far fewer SADs than previous studies but remained associated with a 2.6-fold higher risk as compared with control deaths. These findings may reflect the evolving contemporary epidemiology of SCD.