Vol 17, No 1 (2010)
Review Article
Published online: 2010-01-26
Pathophysiology, risk stratification, and management of sudden cardiac death in coronary artery disease
Cardiol J 2010;17(1):4-10.
Abstract
Management of sudden cardiac death (SCD) is undergoing radical change in direction. It is
becoming increasingly appreciated that besides depressed left ventricular systolic function and
the conventional risk stratification tools, new markers for plaque vulnerability, enhanced
thrombogenesis, specific genetic alterations of the autonomic nervous system, cardiac sarcolemmal
and contractile proteins, and familial clustering may better segregate patients with
atherosclerotic coronary artery disease (CAD) who are at high risk of SCD from those who may
suffer from nonfatal ischemic events. Better understanding of pathophysiologic processes such
as post-myocardial infarction remodeling, the transition from compensated hypertrophy to
heart failure, and the increased cardiovascular risk of CAD in the presence of diabetes or even
a pre-diabetic state will help to improve both risk stratification and management. The rapidly
developing fields of microchips technology, and proteomics may allow rapid and cost-effective
mass screening of multiple risk factors for SCD. The ultimate goal is not only to change the
current direction of management strategy of SCD away from increased ICD utilization, but to
identify novel methods for risk stratification, risk modification, and prevention of SCD that
could be applied to the general public at large.
(Cardiol J 2010; 17, 1: 4-10)
(Cardiol J 2010; 17, 1: 4-10)
Keywords: sudden cardiac death cascadediabetes and sudden cardiac deaththe autonomic nervous systempost infarction remodelingsystolic dysfunctiongenetics