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Background  Sudden cardiac death ( SCD ) is often the first presentation of ischemic heart disease; however, there is limited information on  SCD  among women with and without obstructive coronary artery disease ( CAD ). We evaluated  SCD  incidence in the WISE (Women's Ischemia Syndrome Evaluation) study.    Methods and Results  Overall, 904 women with suspected ischemic heart disease with preserved ejection fraction and core laboratory coronary angiography were followed for outcomes. In case of death, a death certificate and/or a physician or family narrative of the circumstances of death was obtained. A clinical events committee rated all deaths as cardiovascular or noncardiovascular and as  SCD  or non‐ SCD . In total, 96 women (11%) died over a median of 6 years (maximum: 8 years). Among 65 cardiovascular deaths, 42% were  SCD . Mortality per 1000 person‐hours increased linearly with  CAD  severity (no  CAD : 5.8; minimal: 15.9; obstructive: 38.6;  P <0.0001). However, the proportion of  SCD  was similar across  CAD  severity: 40%, 58%, and 38% for no, minimal, and obstructive  CAD  subgroups, respectively ( P  value not significant). In addition to traditional risk factors (age, diabetes mellitus, smoking), a history of depression ( P =0.018) and longer corrected QT interval ( P =0.023) were independent  SCD  predictors in the entire cohort. Corrected QT interval was an independent predictor of  SCD  in women without obstructive  CAD  ( P =0.033).    Conclusions   SCD  contributes substantially to mortality in women with and without obstructive  CAD . Corrected QT interval is the single independent  SCD  risk factor in women without obstructive  CAD . In addition to management of traditional risk factors, these data indicate that further investigation should address mechanistic understanding and interventions targeting depression and corrected QT interval in women.

journal of the american heart association

Sudden Cardiac Death in Women With Suspected Ischemic Heart Disease, Preserved Ejection Fraction, and No Obstructive Coronary Artery Disease: A Report From the Women's Ischemia Syndrome Evaluation Study