Sudden Cardiac Death in Koreasummitmd.com/pdf/pdf/6_Seok-Min Kang.pdf · Sudden Cardiac Death in Korea : Epidemiology and Risk Factors Seok-Min Kang, MD, Ph D. Director, Heart Failure

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

Contents

• Definition of SCD

• Epidemiology in USA and Korea

• Risk Factors

• Clinical Cases

• Screening and Prevention in Korea

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

• Approximately 250,000 - 400,000 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

In United States

• 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

Incidence of SCD in specific populations

Myerburg RJ, et al. Circulation, 1998

Group

1 U.S. Census Bureau, Statistical Abstract of the United States: 2001.2 American Cancer Society, Inc., Surveillance Research, Cancer Facts and Figures 2001.3 2002 Heart and Stroke Statistical Update, American Heart Association.4 Circulation. 2001;104:2158-2163.

SCA claims more lives each year than these other diseases

combined.

Magnitude of SCA in the US

0

100,000

200,000

300,000

400,000

500,000

AIDS BreastCancer

LungCancer

Stroke SCA

# d

ea

ths

/ye

ar

1

2 2

3 4

42,156 40,600

157,400 167,366

450,000

407,522

• 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 %)

In Korea

Lee YS. J Korean Med Assoc, 1998

Cho JG, et al. Jpn Circ J, 2001

More common in middle-aged males

In Korea

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%)

Nonspecific2(5%)

3. CAD or spasm 7(16%)

4. Valvular disease 1(2%)

5. None 11 (26%)

Clinical Profile of ICD Implanted Patients

in Severance CV Hospital (1997-2006)

Clinical manifestation Aborted sudden cardiac death 23 (53%)

ASCD: 1st 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%)

Clinical Profile of ICD Implanted Patients

in Severance CV Hospital (1997-2006)

Pathophysiologyand

Epidemiology of SCD

Huikuri H, et al. NEJM, 2001

Antezano ES, et al.

J Intensive Care Med, 2003

Anatomic/Functional

Substrate

Transient

Initiating Events

Arrhythmia Mechanisms

Indicators of increased risk of SCDVariable Measure Predictive power

Risk of sudden death by decile of multivariant risk

: 26-year follow-up, the Framingham Study

Kannel WB, et al. J Am Coll Cardiol 1985:5[Suppl 6]:141B

Age, sBP, HR, LVH, intraventricular block, nonspecific ECG abnormalities,

Vital capacity, relative weight, Cigarettes consumption, Seum cholesterol

SCD and Clincal Subsets

Myerburg RJ. et al. J Cardiovasc Electrophysiol 2001:12;369

5-10%7-15%

20%

30%

~ 33%

100

50

40

30

20

10

0

Pro

po

rtio

n o

f S

CD

s (

%)

Arrhythmic

Risk markers

Hemodynamic

Risk markers

Acute MI;

Unstable AP

First event Known disease;

Low risk profile

> 2/3

< 25%

SCD in athletes

Maron BJ et al, Circulation 119:1085, 2009

• 최다 유전성 심근병증– 1/500 (0.2%) 유병율

• 상염생체 우성 유전– 환자 자식의 50%는 질병

유전자 보유

• 청년기 심장 돌연사의가장 중요한 원인

Hypertrophic CMP

Beta Mysosin Heavy Chain, Troponin ,

Myosin Binding Protein C, Alpha Tropomyosin, etc

<질병관리본부 학술연구용역사업>

한국인 유전성(가족성) 심근병증 유전자 발굴을위한 임상자료 및 유전체자원 수집

강석민(연구 책임자), 홍그루, 연세대학교 의과대학, 신촌 세브란스 병원

김계훈, 전남대학교 의과대학, 전남대 병원

김 웅, 영남대학교 의과대학, 영남대 병원

Familial Hypertrophic CMP Registry

Genetic Evaluation of CMP

Hershberger RE, et al. J Cardiac Fail, 2009;15:83-97

HCMP DCMP RCMP

Non-compaction ARVD

Screening is very important !

Prevention of SCD

Chain of Survival