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. 2020 May 20.
doi: 10.1161/CIRCEP.119.007908. Online ahead of print.

Physical Activity and the Risk for Sudden Cardiac Death in Patients With Coronary Artery Disease


Physical Activity and the Risk for Sudden Cardiac Death in Patients With Coronary Artery Disease

Mikko P Tulppo et al. Circ Arrhythm Electrophysiol. .


Background - The association between leisure time physical activity (LTPA) and the risk of sudden cardiac death (SCD) in coronary artery disease (CAD) patients is not well known. We aim to assess whether there is an association between LTPA and the risk of SCD and non-SCD in CAD patients. Methods - Patients with angiographically verified CAD (n=1,946) underwent a clinical evaluation including filling in a LTPA questionnaire and extensive risk profiling at the baseline. The patients were classified into four groups according to LTPA: 1) Inactive; 2) Irregularly active; 3) Active, exercise regularly 2-3 times weekly; 4) Highly active, exercise regularly four times or more weekly. Age, sex, body mass index (BMI), left ventricular ejection fraction, type 2 diabetes, history of myocardial infarction, Canadian Cardiovascular Society grading of angina pectoris (CCS-class) and exercise capacity were used as covariates in the multivariate Cox regression analysis. Results - During follow-up (median 6.3 years), 52 SCDs and 49 non-SCDs occurred. Inactive patients had increased risk for SCD compared with active patients (HR: 2.45, 95 % CI: 1.01-5.98, p<0.05). A significant LTPA*CCS-class interaction was observed in SCD risk (p=0.019 in highly active patients). LTPA was not associated with SCD in patients with CCS-class 1 (n=1107, 18 events). Among patients with CCS-class 2 or higher (n=839, 34 events), increased risk for SCD was encountered in highly active patients (HR: 7.46, 95 % CI: 2.32-23.9; p<0.001) and inactive patients (HR: 3.64, 95 % CI: 1.16-11.5; p<0.05) as compared to active patients. A linear association was observed between LTPA and non-SCD, those with high LTPA had the lowest risk for non-SCD. Conclusions - Inactive CAD patients had increased risk for SCD. In subgroup analysis among symptomatic patients, the risk of SCD was increased in highly active and inactive patients compared with active patients.

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