Abstract 10184: The Risk Factors for Ischemic Sudden Cardiac Death in Women

Abstract

Background: Sudden cardiac death (SCD) is a significant cause of death accounting for 15-20 % of all deaths in Western countries. Coronary artery disease (CAD) is the most common cause of SCD. Even though women are at a lower risk for SCD & CAD, the decline in mortality of these conditions has been slower in women than in men. Previous studies have shown that CAD is more challenging to detect in women, hence SCD is often the first manifestation of underlying CAD among women. The aim of this case-control study was to determine factors associated to SCD due to CAD in women. Methods: The study group consists of women with ischemic SCD (N=888) derived from the Fingesture study conducted in Northern Finland from 1998 to 2017 and all SCDs were autopsy verified. The control group consisted of women with angiographically verified CAD without SCD occurring during the 5-year-follow-up (N=610) from Artemis study. To perform comparison between these groups, we utilized medical records, autopsy findings, echocardiograms and ECGs. Results: Subjects with SCD were older (73.2±11.3 vs. 68.8±8.0 p < 0.001) and were more likely to be smokers or ex-smokers (37.1% vs. 27.6 %, p = 0.045). The proportion of subjects with prior myocardial infarction (MI) was higher in controls (46.9 % vs. 41.4 % in SCD subjects, p = 0.037), but in contrast, SCD subjects were more likely to have underlying silent MI (25.6 % vs. 2.4 % in CAD controls, p < 0.001). Decreased left ventricular ejection fraction (LVEF 35-55 %) was more common finding in SCD subjects than in CAD controls (33.1% vs. 8.7 %, p < 0.001, respectively) as well as LV hypertrophy (70.9 % vs. 55.1 %, p < 0.001, respectively). Various ECG-abnormalities were more common in SCD subjects including higher heart rate, prolonged QTc- and JTc-intervals, wide or fragmented QRS-complex, short PR-interval and early repolarization. The prevalence of Q-waves and T-inversions did not differ between these groups. Conclusions: Underlying CAD and MI are often underdiagnosed in women with ischemic SCD considering the high proportion of silent myocardial infarctions and the number of subjects without prior CAD diagnosis. LV hypertrophy as well as decreased LVEF were more frequent findings in SCD subjects. Several ECG abnormalities were more common among subjects with SCD.