Clinical and Angiographic Characteristics of Patients with Acute Coronary Syndrome Associated with Sudden Cardiac Death

Introduction: Sudden death (SD) is in most cases due to cardiac causes, mainly secondary to ischemic heart disease. However, the angiographic characteristics in SD survivors in the context of an acute coronary syndrome (ACS) remain controversial. The aim of this study was to evaluate the clinical and angiographic characteristics of patients who suffered cardiac arrest during an ACS. Methods: We evaluated 46 patients with SD related to ACS, who were divided into two groups according to their presentation: an ST-elevation myocardial infarction (SD-STEMI) group and a non ST-elevation myocardial infarction (SD-NSTEMI) group. Consecutive STEMI patients without SD served as a double size-matched control group. We compared the clinical and angiographic characteristics and the in-hospital mortality between groups. Results: Patients in the SD-NSTEMI group (n=13) were older and had a higher incidence of hypertension. The left anterior descending coronary artery was the most frequent culprit vessel in all groups. SD-STEMI patients (n=33) had a higher prevalence of proximal coronary culprit segment involvement than did the non-SD STEMI group (75% vs. 36.3%, p<0.001). The SD-NSTEMI group was characterized by multivessel and multi-segment disease. Outcomes were similar for both SD groups. Conclusion: SD in patients with NSTEMI occurred in patients who were older, with more cardiovascular risk factors, diffuse and multivessel coronary disease, complex coronary lesions, and a lower rate of angioplasty success as compared with the STEMI group. SD STEMI patients had a significant higher association with proximal coronary acute occlusion than STEMI patients without SD.