Elsevier

The American Journal of Cardiology

Volume 188, 1 February 2023, Pages 44-51
The American Journal of Cardiology

Time Trend in Incidence of Sudden Cardiac Death After Percutaneous Coronary Intervention from 2009 to 2017 (from the Japanese Multicenter Registry)

https://doi.org/10.1016/j.amjcard.2022.11.019Get rights and content

The advances in the integrated management of patients with coronary artery disease undergoing percutaneous coronary intervention (PCI) have reduced subsequent cardiovascular events. Nonetheless, sudden cardiac death (SCD) remains a major concern. Therefore, we aimed to investigate the time trend in SCD incidence after PCI and to identify the clinical factors contributing to SCD. From a prospective, multicenter cohort registry in Japan, 8,723 consecutive patients with coronary artery disease undergoing PCI between 2009 and 2017 were included. We evaluated the SCD incidence 2 years after PCI; all death events were adjudicated, and SCD was defined as unexpected death without a noncardiovascular cause in a previously stable patient within 24 hours from the onset. The Fine and Gray method was used to identify the factors associated with SCD. Overall, the mean age of the patients was 68.3 ± 11.3 years, and 1,173 patients (13.4%) had heart failure (HF). During the study period, the use of second-generation drug-eluting stents increased. The 2-year cumulative incidence of all-cause mortality and SCD was 4.29% and 0.45%, respectively. All-cause mortality remained stable during the study period (p for trend = 0.98), whereas the crude incidence of SCD tended to decrease over the study period (p for trend = 0.052). HF was the strongest predictor associated with the risk of SCD (crude incidence [vs non-HF] 2.13% vs 0.19%; p <0.001). In conclusion, the incidence of SCD after PCI decreased over the last decade, albeit the high incidence of SCD among patients with HF remains concerning.

Section snippets

Methods

This study was conducted as part of the Japan Cardiovascular Database-Keio Interhospital Cardiovascular Studies (JCD-KiCS) PCI registry. This is a multicenter, prospective registry that includes data of consecutive patients who underwent PCI between 2009 and 2017 at 15 institutions within the Tokyo metropolitan area. It includes primarily large tertiary care referral centers (≥200 beds; n = 13) and a few midsized satellite hospitals (<200 beds; n = 2). The details of this registry have been

Results

The baseline characteristics of the patients (n = 8,723) are summarized in Table 1. The patients’ baseline characteristics changed between 2009 and 2017 (Table 1). The prevalence of old MI (p for trend <0.001) and HF decreased (p for trend = 0.027), whereas mean LVEF and age increased (p for trend <0.001 for both). Furthermore, the principal indication for PCI shifted from ACS to stable CAD. Regarding medications at discharge, there was a temporal increase in statins and P2Y12 inhibitors (all p

Discussion

In this study, we observed the following: (1) the 2-year crude incidence of SCD after PCI was approximately 0.4% and decreased during the study period, (2) the proportion of the second-generation DES implantation increased after the approval for its use, (3) the incidence of SCD was almost similar between patients with ACS and those with stable CAD, whereas SCDs occurred more frequently immediately after PCI in those with ACS, and (4) the HF and prescription of statins were associated with

Disclosures

Dr Kohsaka reports investigator-initiated grant funding from Bayer and Daiichi Sankyo. The remaining authors have no conflicts of interest to declare. Dr. Ikemura received an unrestricted research grant for the Department of Cardiology, Keio University School of Medicine from Bristol Myer Squibb.

Acknowledgment

The authors would like to thank the members of the cardiac catheterization laboratories of the participating institutions and the clinical research coordinators involved in the JCD-KiCS study. The English language editing (Editage, https://www.editage.jp) in this study was supported by a Grant-in-Aid for Scientific Research (Japan Society for the Promotion of Science KAKENHI; 22K16067).

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    Funding: The present study was funded by the Grants-in-Aid for Scientific Research KAKENHI; Nos. 20H03915 from the Japan Society for the Promotion of Science.

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