Patients with coronary artery disease (CAD) with a left ventricular ejection fraction (LVEF) of more than 30% to 35%, diabetes and high haemoglobin A1c (HbA1c) are at much higher absolute risk of dying from non sudden arrhythmic death than sudden and/or arrhythmic death, finds a new study.
The study has been published in the journal JACC: Clinical Electrophysiology.
Patients with Coronary artery disease and Diabetes are at elevated risk for sudden and/or arrhythmic death (SAD); however, it is unclear whether these patients would benefit from implantable cardioverter-defibrillators given competing causes of death and/or whether HbA1c might augment SAD risk stratification.
This study sought to determine the absolute and relative associations of diabetes mellitus (DM) and hemoglobin A1c (HbA1c) with sudden and/or arrhythmic death (SAD) versus other modes of death in patients with coronary artery disease (CAD) who do not qualify for implantable cardioverter-defibrillators.
The findings in this study lead by Dr. Ramkumar highlights the need for improved SAD risk classification in diabetic and coronary artery disease patients, ideally by identifying risk factors and/or biomarkers that may distinguish between SAD and non-SAD risk.
This was a PRE-DETERMINE trial comprised 5764 patients with CAD or previous myocardial infarction, an LVEF of more than 35 percent or 30 percent to 35 percent, and New York Heart Association (NYHA) functional class I heart failure symptoms in a multicenter, observational research.
The absolute and relative risks of SAD with mortality from other causes (non-SAD) were examined in this cohort, which was stratified by diabetes status and HbA1c levels. The researchers also wanted to know if there were any risk factors for SAD in diabetic individuals.
Key Findings of this study:
The individuals with diabetes had substantially higher median HbA1c level than those without diabetes (5.6 percent vs 6.7 percent, respectively).
The estimated 6.8-year cumulative incidence of SAD in diabetic individuals was higher than non-diabetic people (4.8 percent and 2.8 percent).
Among patients with diabetes and patients without diabetes, the estimated 6.8-year cumulative incidence of non-SAD was 4-fold greater than SAD.
Low LVEF (50 percent), atrial fibrillation, and a high ECG score were all found to be substantially related with an elevated risk of sudden and/or arrhythmic death (SAD) in diabetic individuals.
The authors concluded that this data brings us to the need for better SAD risk demarcation in patients with diabetes and CAD. Identifying the risk factors and biomarkers can help greatly in discriminating between SAD and non-SAD risk. And this study is an effort to bring in more advanced tailored medical interventions in the near future.
This article "Diabetes and Risk of Sudden Death in Coronary Artery Disease Patients Without Severe Systolic Dysfunction" is published online in the Journal of the American College of Cardiology: Clinical Electrophysiology on 28 July 2021.
Source
Ramkumar V. Venkateswaran, M.V. Moorthy, Neal A. Chatterjee, Julie Pester, Alan H. Kadish, Daniel C. Lee, Nancy R. Cook, Christine M. Albert, Diabetes and Risk of Sudden Death in Coronary Artery Disease Patients Without Severe Systolic Dysfunction, JACC: Clinical Electrophysiology, 2021
https://doi.org/10.1016/j.jacep.2021.05.014