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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