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Risk stratification for sudden cardiac death: current approaches and predictive value.

Lopera G, Curtis AB - Curr Cardiol Rev (2009)

Bottom Line: Current risk stratification strategies fail to identify patients at risk of SCD in larger population groups encompassing a greater number of potential SCD victims.However, the best approach to identifying patients and the value of various risk stratification tools is not entirely clear.The goal of this review is to discuss the problem of SCD and the value of the different risk stratification markers and their potential clinical use either alone or in combination with other risk stratification markers.

View Article: PubMed Central - PubMed

Affiliation: Division of Cardiology, University of Miami/Miller School of Medicine, Miami, FL, USA.

ABSTRACT
Sudden cardiac death (SCD) is a serious public health problem; the annual incidence of out-of-hospital cardiac arrest in North America is approximately 166,200. Identifying patients at risk is a difficult proposition. At the present time, left ventricular ejection fraction (LVEF) remains the single most important marker for risk stratification. According to current guidelines, most patients with LVEF <35% could benefit from prophylactic ICD implantation, particularly in the setting of symptomatic heart failure. Current risk stratification strategies fail to identify patients at risk of SCD in larger population groups encompassing a greater number of potential SCD victims. However, the best approach to identifying patients and the value of various risk stratification tools is not entirely clear. The goal of this review is to discuss the problem of SCD and the value of the different risk stratification markers and their potential clinical use either alone or in combination with other risk stratification markers.

No MeSH data available.


Related in: MedlinePlus

The number needed to treat to save a life varies depending on the risk stratification tools used: 4 when MADIT I/MUSTT risk stratification was used; 18 in MADIT II. However, if TWA was used in MADIT II-like patients, the number needed to treat to save a life changes to 9 if TWA non-negative or 76 if TWA negative. TWA=T wave alternans.
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Figure 2: The number needed to treat to save a life varies depending on the risk stratification tools used: 4 when MADIT I/MUSTT risk stratification was used; 18 in MADIT II. However, if TWA was used in MADIT II-like patients, the number needed to treat to save a life changes to 9 if TWA non-negative or 76 if TWA negative. TWA=T wave alternans.

Mentions: After multivariable adjustment, among the 392 (51%) patients who received ICDs in this multicenter trial, ICDs were associated with lower all-cause mortality in non-negative TWA patients (HR=0.45, p=0.003) but not in the negative TWA patients (HR=0.85, p=0.73), with the mortality benefit in non-negative TWA patients largely due to reduction of arrhythmic mortality (p=0.004). The NNT with an ICD for two years to save one life was 9 among non-negative TWA patients and 76 among negative TWA patients [38] (Fig. 2). Moreover, the observed mortality in this trial was 8.26% (n=254) versus 15.17% (n=514) in the negative TWA and non-negative TWA groups, respectively. In our opinion, the mortality in both groups is clinically significant and, therefore, it cannot be concluded that there is no significant benefit from ICD therapy in the negative TWA group, since data from seven primary prevention ICD trials showed an average 28% RRR and 3% absolute risk reduction of death in ICD treated patients as compared to medical therapy.


Risk stratification for sudden cardiac death: current approaches and predictive value.

Lopera G, Curtis AB - Curr Cardiol Rev (2009)

The number needed to treat to save a life varies depending on the risk stratification tools used: 4 when MADIT I/MUSTT risk stratification was used; 18 in MADIT II. However, if TWA was used in MADIT II-like patients, the number needed to treat to save a life changes to 9 if TWA non-negative or 76 if TWA negative. TWA=T wave alternans.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2803290&req=5

Figure 2: The number needed to treat to save a life varies depending on the risk stratification tools used: 4 when MADIT I/MUSTT risk stratification was used; 18 in MADIT II. However, if TWA was used in MADIT II-like patients, the number needed to treat to save a life changes to 9 if TWA non-negative or 76 if TWA negative. TWA=T wave alternans.
Mentions: After multivariable adjustment, among the 392 (51%) patients who received ICDs in this multicenter trial, ICDs were associated with lower all-cause mortality in non-negative TWA patients (HR=0.45, p=0.003) but not in the negative TWA patients (HR=0.85, p=0.73), with the mortality benefit in non-negative TWA patients largely due to reduction of arrhythmic mortality (p=0.004). The NNT with an ICD for two years to save one life was 9 among non-negative TWA patients and 76 among negative TWA patients [38] (Fig. 2). Moreover, the observed mortality in this trial was 8.26% (n=254) versus 15.17% (n=514) in the negative TWA and non-negative TWA groups, respectively. In our opinion, the mortality in both groups is clinically significant and, therefore, it cannot be concluded that there is no significant benefit from ICD therapy in the negative TWA group, since data from seven primary prevention ICD trials showed an average 28% RRR and 3% absolute risk reduction of death in ICD treated patients as compared to medical therapy.

Bottom Line: Current risk stratification strategies fail to identify patients at risk of SCD in larger population groups encompassing a greater number of potential SCD victims.However, the best approach to identifying patients and the value of various risk stratification tools is not entirely clear.The goal of this review is to discuss the problem of SCD and the value of the different risk stratification markers and their potential clinical use either alone or in combination with other risk stratification markers.

View Article: PubMed Central - PubMed

Affiliation: Division of Cardiology, University of Miami/Miller School of Medicine, Miami, FL, USA.

ABSTRACT
Sudden cardiac death (SCD) is a serious public health problem; the annual incidence of out-of-hospital cardiac arrest in North America is approximately 166,200. Identifying patients at risk is a difficult proposition. At the present time, left ventricular ejection fraction (LVEF) remains the single most important marker for risk stratification. According to current guidelines, most patients with LVEF <35% could benefit from prophylactic ICD implantation, particularly in the setting of symptomatic heart failure. Current risk stratification strategies fail to identify patients at risk of SCD in larger population groups encompassing a greater number of potential SCD victims. However, the best approach to identifying patients and the value of various risk stratification tools is not entirely clear. The goal of this review is to discuss the problem of SCD and the value of the different risk stratification markers and their potential clinical use either alone or in combination with other risk stratification markers.

No MeSH data available.


Related in: MedlinePlus