Sudden Cardiac Death in Korea : Epidemiology and Risk Factors
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1 Sudden Cardiac Death in Korea : Epidemiology and Risk Factors Seok-Min Kang, MD, Ph D. Director, Heart Failure & Cardiac Wellness Center, Professor, Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
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3 Contents Definition of SCD Epidemiology in USA and Korea Risk Factors Clinical Cases Screening and Prevention in Korea
4 Definition Unexpected natural death from a cardiac cause by abrupt loss of consciousness within a short time generally less than 1 hour from the onset of symptoms Any cardiac death occurring out of the hospital or taking place in the ER or dead on arrival in the ER
5 In United States Approximately 250, ,000 deaths annually Incidences of SCD increases with age 2 to 3 times higher among men than women 20-25% : 1st manifestation of CVD High recurrence rate : > 50% of SCD survivors within 1yr
6 Of the 456,076 SCDs in 1998, ( > 35 yrs) 51.6 % (women) 82.8 % (older than 65 yrs) Mean age ( 70.0 yrs in men, 82.4 yrs in women) Zheng, et al. MMWR, 2002
7 Incidence of SCD in specific populations Group Myerburg RJ, et al. Circulation, 1998
8 # deaths/year Magnitude of SCA in the US 500, , , , ,000 42,156 40, , , , , AIDS Breast Lung Stroke SCA 2 Cancer 2 Cancer SCA claims more lives each year than these other diseases combined. 1 U.S. Census Bureau, Statistical Abstract of the United States: American Cancer Society, Inc., Surveillance Research, Cancer Facts and Figures Heart and Stroke Statistical Update, American Heart Association. 4 Circulation. 2001;104:
9 In Korea Incidence of SCD is increasing with the rapid increase in CAD over the past 10 yrs Emerges as an important national health problem According to the report (51-yr experience of autopsies, from 1946 to 1996 at Korea National Institute of Scientific Investigation) CV diseases (49.7 %) less than the USA CNS diseases (13.6 %) Pulm. diseases (13.9 %) Lee YS. J Korean Med Assoc, 1998
10 In Korea More common in middle-aged males Cho JG, et al. Jpn Circ J, 2001
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12 Clinical Profile of ICD Implanted Patients in Severance CV Hospital ( ) Gender Male: Female 37 ( 86%) : 6 (14%) Age (years) Mean 48.5 ± 11.6 (14 77) Heart disease 1. Brugada 13 (30%) 2. Cardiomyopathy 11 (26%) DCMP 4 (9%) HCMP 5 (12%) Nonspecific 2(5%) 3. CAD or spasm 7(16%) 4. Valvular disease 1(2%) 5. None 11 (26%)
13 Clinical Profile of ICD Implanted Patients in Severance CV Hospital ( ) Clinical manifestation Aborted sudden cardiac death 23 (53%) ASCD: 1 st Presentation 8 (19%) Syncope followed by ASCD 13 (30%) Presyncope followed by ASCD 1 (2%) Palpitation followed by ASCD 1 (2%) Syncope 14 (33%) Palpitation 5 (12%) Dyspnea 1 (2%) Documented arrhythmia VF 17 (40%) VT 14 (33%) VPC 1 (2%) Asystole 1 (2%) Atrial flutter, sinus pause 2 (5%) None 8 (19%)
14 Pathophysiology and Epidemiology of SCD Huikuri H, et al. NEJM, 2001
15 Anatomic/Functional Substrate Transient Initiating Events Antezano ES, et al. J Intensive Care Med, 2003 Arrhythmia Mechanisms
16 Indicators of increased risk of SCD Variable Measure Predictive power
17 Risk of sudden death by decile of multivariant risk : 26-year follow-up, the Framingham Study Age, sbp, HR, LVH, intraventricular block, nonspecific ECG abnormalities, Vital capacity, relative weight, Cigarettes consumption, Seum cholesterol Kannel WB, et al. J Am Coll Cardiol 1985:5[Suppl 6]:141B
18 Proportion of SCDs (%) SCD and Clincal Subsets > 2/3 40 < 25% 30% ~ 33% % 7-15% 20% 0 Arrhythmic Risk markers Hemodynamic Risk markers Acute MI; Unstable AP First event Known disease; Low risk profile Myerburg RJ. et al. J Cardiovasc Electrophysiol 2001:12;369
19 SCD in athletes Maron BJ et al, Circulation 119:1085, 2009
20 Hypertrophic CMP 최다유전성심근병증 1/500 (0.2%) 유병율 상염생체우성유전 환자자식의 50% 는질병유전자보유 청년기심장돌연사의가장중요한원인 Beta Mysosin Heavy Chain, Troponin, Myosin Binding Protein C, Alpha Tropomyosin, etc
21 < 질병관리본부학술연구용역사업 > 한국인유전성 ( 가족성 ) 심근병증유전자발굴을위한임상자료및유전체자원수집 강석민 ( 연구책임자 ), 홍그루, 연세대학교의과대학, 신촌세브란스병원 김계훈, 전남대학교의과대학, 전남대병원 김웅, 영남대학교의과대학, 영남대병원
22 Familial Hypertrophic CMP Registry
23 Genetic Evaluation of CMP HCMP DCMP RCMP Non-compaction ARVD Hershberger RE, et al. J Cardiac Fail, 2009;15:83-97
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26 Screening is very important!
27 Prevention of SCD
28 Chain of Survival
29
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