rpcardioRational Pharmacotherapy in CardiologyРациональная Фармакотерапия в Кардиологии1819-64462225-3653«SILICEA-POLIGRAF» LLC10.20996/1819-6446-2011-7-2-212-218rpcardio-752Research ArticlePOINT OF VIEWТОЧКА ЗРЕНИЯSUDDEN CARDIAC DEATH: PROBLEM OF RISK STRATIFICATION AND CHOICE OF THERAPYВНЕЗАПНАЯ СЕРДЕЧНАЯ СМЕРТЬ: ПРОБЛЕМА СТРАТИФИКАЦИИ РИСКА И ВЫБОРА ЛЕКАРСТВЕННОГО ПРЕПАРАТАФилипповЕ. В.FilippovE. V.

к.м.н., ассистент кафедры госпитальной терапии

dr.philippov@gmail.comЯкушинС. С.YakushinS. S.

д.м.н., профессор, заведующий кафедрой госпитальной терапии

Рязанский Государственный Медицинский Университет им. акад. И.П. ПавловаРоссияRyazan State Medical UniversityRussian Federation20111401201672212218Copyright © Filippov E.V., Yakushin S.S., 20162016Филиппов Е.В., Якушин С.С.Filippov E.V., Yakushin S.S.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.rpcardio.online/jour/article/view/752

The main issues of sudden cardiac death (SCD) epidemiology and risk stratification were considered. High efficacy SCD prevention with implanted cardioverter-defibrillators is shown. However they are rarely implemented in the real practice. That is why the main current approach to SCD prevention is pharmacotherapy. Overview of various drugs is given. The largest evidence base and proven efficacy have beta-blockers among all available drugs for SCD prevention.

Рассмотрены основные вопросы эпидемиологии и стратификации риска внезапной сердечной смерти (ВСС). Показано, что наиболее эффективным методом профилактики ВСС является имплантация кардиовертера-дефибриллятора. Однако в связи с редким использованием в практике данной технологии основным направлением профилактики в настоящее время является лекарственная терапия. Дан обзор различных лекарственных средств. Показано, что наибольшей доказательной базой и эффективностью среди них обладают бета-блокаторы.

внезапная сердечная смертьбета-блокаторстратификация рискаsudden cardiac deathbeta-blockerrisk stratificationReferencesLown B. The lost art of healing. Boston: Houghton Mifflin Company; 1996.Lown B. The lost art of healing. Boston: Houghton Mifflin Company; 1996.Libby P., Bonow R.O., Zipes D.P., Mann D.L. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine, 8th edition. Philadelphia: Saunders Elsevier; 2008.Libby P., Bonow R.O., Zipes D.P., Mann D.L. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine, 8th edition. Philadelphia: Saunders Elsevier; 2008.de Vreede-Swagemakers J.J., Gorgels A.P., Dubois-Arbouw W.I., et al. Out-of-hospital cardiac arrest in the 1990's: a population-based study in the Maastricht area on incidence, characteristics and survival. J Am Coll Cardiol 1997:30(6):1500-05.de Vreede-Swagemakers J.J., Gorgels A.P., Dubois-Arbouw W.I., et al. Out-of-hospital cardiac arrest in the 1990's: a population-based study in the Maastricht area on incidence, characteristics and survival. J Am Coll Cardiol 1997:30(6):1500-05.Jouven X., Desnos M., Guerot C., Ducimetière P. Predicting sudden death in the population: the Paris Prospective Study I. Circulation 1999;99(15):1978-83.Jouven X., Desnos M., Guerot C., Ducimetière P. Predicting sudden death in the population: the Paris Prospective Study I. Circulation 1999;99(15):1978-83.Gregoratos G., Abrams J., Epstein A.E., et al. ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices: Summary Article: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/NASPE Committee to Update the 1998 Pacemaker Guidelines). Circulation 2002;106:2145-61.Gregoratos G., Abrams J., Epstein A.E., et al. ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices: Summary Article: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/NASPE Committee to Update the 1998 Pacemaker Guidelines). Circulation 2002;106:2145-61.Weisfeldt M.L., Everson-Stewart S., Sitlani C. et al. Ventricular Tachyarrhythmias after Cardiac Arrest in Public versus at Home. N Engl J Med 2011;364:313-21.Weisfeldt M.L., Everson-Stewart S., Sitlani C. et al. Ventricular Tachyarrhythmias after Cardiac Arrest in Public versus at Home. N Engl J Med 2011;364:313-21.Bokeriya L.A., Bokeriya O.L., Kislitsina O.N. Randomized clinical trials for the prevention of sudden cardiac death: principles and totals. Annaly Aritmologii 2010;2:5-14. Russian (Бокерия Л.А., Бокерия О.Л., Кислицина О.Н. Рандомизированные клинические исследования по профилактике внезапной сердечной смерти: принципы и итоговые показатели. Анналы Аритмологии 2010;2:5-14).Bokeriya L.A., Bokeriya O.L., Kislitsina O.N. Randomized clinical trials for the prevention of sudden cardiac death: principles and totals. Annaly Aritmologii 2010;2:5-14. Russian (Бокерия Л.А., Бокерия О.Л., Кислицина О.Н. Рандомизированные клинические исследования по профилактике внезапной сердечной смерти: принципы и итоговые показатели. Анналы Аритмологии 2010;2:5-14).Oganov R.G., Shal'nova S.A., Kalinina A.M. Prevention of cardiovascular disease. M.: GEOTAR-Media; 2009. Russian (Оганов Р.Г., Шальнова С.А., Калинина А.М. Профилактика сердечно-сосудистых заболеваний. М.: ГЭОТАР-Медиа; 2009).Oganov R.G., Shal'nova S.A., Kalinina A.M. Prevention of cardiovascular disease. M.: GEOTAR-Media; 2009. Russian (Оганов Р.Г., Шальнова С.А., Калинина А.М. Профилактика сердечно-сосудистых заболеваний. М.: ГЭОТАР-Медиа; 2009).Ganelina I.E., Churina S.K. Professional composition of patients with myocardial infarction and sudden death from coronary heart disease aged 49 years. Sovetskaya Meditsina 1986;4:65-70. Russian (Ганелина И.Е., Чурина С.К. Профессиональный состав больных инфарктом миокарда и умерших внезапно от ИБС в возрасте до 49 лет. Советская Медицина 1986;4:65-70).Ganelina I.E., Churina S.K. Professional composition of patients with myocardial infarction and sudden death from coronary heart disease aged 49 years. Sovetskaya Meditsina 1986;4:65-70. Russian (Ганелина И.Е., Чурина С.К. Профессиональный состав больных инфарктом миокарда и умерших внезапно от ИБС в возрасте до 49 лет. Советская Медицина 1986;4:65-70).Ardashev A.V., editor. Clinical arrhythmology. Moscow: Medpraktika-M; 2009. Russian (Ардашев А.В., редактор. Клиническая аритмология. М.: Медпрактика-М; 2009).Ardashev A.V., editor. Clinical arrhythmology. Moscow: Medpraktika-M; 2009. Russian (Ардашев А.В., редактор. Клиническая аритмология. М.: Медпрактика-М; 2009).Zipes D.P., Camm A.J., Borggrefe M. et al. ACC/AHA/ESC 2006 Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: A Report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death): Developed in Collaboration With the European Heart Rhythm Association and the Heart Rhythm Society. Circulation 2006;114:e385-e484.Zipes D.P., Camm A.J., Borggrefe M. et al. ACC/AHA/ESC 2006 Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: A Report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death): Developed in Collaboration With the European Heart Rhythm Association and the Heart Rhythm Society. Circulation 2006;114:e385-e484.Boldueva S.A., Shabrov A.V., Leonova I.A. et al. Clinical and psychological factors affecting sudden death risk in myocardial infarction patients. Kardiovaskulyarnaya terapiya i profilaktika 2007;7:33-37. Russian (Болдуева С.А., Шабров А.В., Леонова И.А. и др. Клинико-психологические факторы, влияющие на риск внезапной смерти у больных, перенесших инфаркт миокарда. Кардиоваскулярная терапия и профилактика 2007;7:59-66).Boldueva S.A., Shabrov A.V., Leonova I.A. et al. Clinical and psychological factors affecting sudden death risk in myocardial infarction patients. Kardiovaskulyarnaya terapiya i profilaktika 2007;7:33-37. Russian (Болдуева С.А., Шабров А.В., Леонова И.А. и др. Клинико-психологические факторы, влияющие на риск внезапной смерти у больных, перенесших инфаркт миокарда. Кардиоваскулярная терапия и профилактика 2007;7:59-66).Committee of Experts on SARF. Arrhythmia: Clinical guidelines for the electrophysiologic studies, catheter ablation and the use of implantable antiarrhythmic devices. Moscow: GEOTAR-Media; 2010. Russian (Комитет экспертов ВНОА. Аритмология: Клинические рекомендации по проведению электрофизиологических исследований, катетерной аблации и применению имплантируемых антиаритмических устройств. М.: ГЭОТАР-Медиа; 2010).Committee of Experts on SARF. Arrhythmia: Clinical guidelines for the electrophysiologic studies, catheter ablation and the use of implantable antiarrhythmic devices. Moscow: GEOTAR-Media; 2010. Russian (Комитет экспертов ВНОА. Аритмология: Клинические рекомендации по проведению электрофизиологических исследований, катетерной аблации и применению имплантируемых антиаритмических устройств. М.: ГЭОТАР-Медиа; 2010).Brugada J., Vardas P., Wolpert C. The EHRA White Book 2009. The Current Status of Cardiac Electrophysiology in ESC Member Countries. France: ESC; 2009.Brugada J., Vardas P., Wolpert C. The EHRA White Book 2009. The Current Status of Cardiac Electrophysiology in ESC Member Countries. France: ESC; 2009.Capucci A., editor. Sudden Cardiac Death. Italy: Informa UK Ltd; 2007.Capucci A., editor. Sudden Cardiac Death. Italy: Informa UK Ltd; 2007.Reiken S., Wehrens X.H., Vest J.A. et al. Beta-Blockers Restore Calcium Release Channel Function and Improve Cardiac Muscle Performance in Human Heart Failure. Circulation 2003;107:2459-66.Reiken S., Wehrens X.H., Vest J.A. et al. Beta-Blockers Restore Calcium Release Channel Function and Improve Cardiac Muscle Performance in Human Heart Failure. Circulation 2003;107:2459-66.Committee of Experts on SCRF. National guidelines for a rational pharmacotherapy of patients with cardiovascular diseases. M.: 2009. Available on: http://scardio.ru/downloads/c4m0i257/recomendacii.doc. Russian (Комитет экспертов ВНОК. Национальные рекомендации по рациональной фармакотерапии больных сердечно-сосудистыми заболеваниями. М.: 2009. Доступно на: http://scardio.ru/downloads/ c4m0i257/ recomendacii.doc).Committee of Experts on SCRF. National guidelines for a rational pharmacotherapy of patients with cardiovascular diseases. M.: 2009. Available on: http://scardio.ru/downloads/c4m0i257/recomendacii.doc. Russian (Комитет экспертов ВНОК. Национальные рекомендации по рациональной фармакотерапии больных сердечно-сосудистыми заболеваниями. М.: 2009. Доступно на: http://scardio.ru/downloads/ c4m0i257/ recomendacii.doc).3-year follow-up of patients randomised in the metoprolol in dilated cardiomyopathy trial. The Metoprolol in Dilated Cardiomyopathy (MDC) Trial Study Group. Lancet 1998;351 (9110):1180-81.3-year follow-up of patients randomised in the metoprolol in dilated cardiomyopathy trial. The Metoprolol in Dilated Cardiomyopathy (MDC) Trial Study Group. Lancet 1998;351 (9110):1180-81.CIBIS Investigators and Committees. A randomized trial of β-blockade in heart failure. The cardiac insufficiency bisoprolol study (CIBIS). Circulation 1994;90:1765–73.CIBIS Investigators and Committees. A randomized trial of β-blockade in heart failure. The cardiac insufficiency bisoprolol study (CIBIS). Circulation 1994;90:1765–73.CIBIS II Investigators and Committees. The cardiac insufficiency bisoprolol study II (CIBIS II): a randomised trial. Lancet 1999;353:9-13.CIBIS II Investigators and Committees. The cardiac insufficiency bisoprolol study II (CIBIS II): a randomised trial. Lancet 1999;353:9-13.MERIT-HF Study Group. Effect of metoprolol CR/XL in chronic heart failure: metoprolol CR/XL randomised intervention trial in congestive heart failure (MERIT HF). Lancet 1999;353:2001-7.MERIT-HF Study Group. Effect of metoprolol CR/XL in chronic heart failure: metoprolol CR/XL randomised intervention trial in congestive heart failure (MERIT HF). Lancet 1999;353:2001-7.Poole-Wilson P.A., Swedberg K., Cleland J.G. et al. Comparison of carvedilol and metoprolol on clinical outcomes in patients with chronic heart failure in the Carvedilol or Metoprolol European Trial (COMET): randomized controlled trial. Lancet 2003;362(9377):7-13.Poole-Wilson P.A., Swedberg K., Cleland J.G. et al. Comparison of carvedilol and metoprolol on clinical outcomes in patients with chronic heart failure in the Carvedilol or Metoprolol European Trial (COMET): randomized controlled trial. Lancet 2003;362(9377):7-13.Wollert K.C., Drexler H. Carvedilol prospective randomized cumulative survival (COPERNICUS) trial: carvedilol as the sun and center of the beta-blocker world? Circulation 2002;106:2164-66.Wollert K.C., Drexler H. Carvedilol prospective randomized cumulative survival (COPERNICUS) trial: carvedilol as the sun and center of the beta-blocker world? Circulation 2002;106:2164-66.Hjalmarson A., Herlitz J., Holmberg S. еt al. The Göteborg metoprolol trial. Effects on mortality and morbidity in acute myocardial infarction. Circulation 1983;67(6Pt2):I26-32.Hjalmarson A., Herlitz J., Holmberg S. еt al. The Göteborg metoprolol trial. Effects on mortality and morbidity in acute myocardial infarction. Circulation 1983;67(6Pt2):I26-32.The MIAMI Trial Research Group: Metoprolol in acute myocardial infarction (MIAMI): A randomized placebo-controlled international trial. Eur Heart J 1985;6(3):199-226.The MIAMI Trial Research Group: Metoprolol in acute myocardial infarction (MIAMI): A randomized placebo-controlled international trial. Eur Heart J 1985;6(3):199-226.Olsson G., Rehnqvist N., Sjögren A. et al. Long-term treatment with metoprolol after myocardial infarction: effect on 3 year mortality and morbidity. J Am Coll Cardiol 1985;5(6):1428-37.Olsson G., Rehnqvist N., Sjögren A. et al. Long-term treatment with metoprolol after myocardial infarction: effect on 3 year mortality and morbidity. J Am Coll Cardiol 1985;5(6):1428-37.Heikki V., Huikuri, Tapanainen J.M. et al. Prediction of sudden cardiac death after myocardial infarction in the beta-blocking era. J Am Coll Cardiol 2003;42:652-58.Heikki V., Huikuri, Tapanainen J.M. et al. Prediction of sudden cardiac death after myocardial infarction in the beta-blocking era. J Am Coll Cardiol 2003;42:652-58.The CAPRICORN Investigators. Effect of carvedilol on outcome after myocardial infarction in patients with left-ventricular dysfunction: the CAPRICORN randomized trial. Lancet 2001;357:1385-90.The CAPRICORN Investigators. Effect of carvedilol on outcome after myocardial infarction in patients with left-ventricular dysfunction: the CAPRICORN randomized trial. Lancet 2001;357:1385-90.Nuttall S.L., Toescu V., Kendall M.J. Beta Blockade after myocardial infarction. Beta blockers have key role in reducing morbidity and mortality after infarction [Letter]. BMJ 2000;320(7234):581.Nuttall S.L., Toescu V., Kendall M.J. Beta Blockade after myocardial infarction. Beta blockers have key role in reducing morbidity and mortality after infarction [Letter]. BMJ 2000;320(7234):581.Wyse D.G., Talajic M., Hafley G.E., et al. Singh for the MUSTT Investigators Antiarrhythmic drug therapy in the Multicenter UnSustained Tachycardia Trial (MUSTT): drug testing and as-treated analysis. J Am Coll Car-diol 2001;38:344-51.Wyse D.G., Talajic M., Hafley G.E., et al. Singh for the MUSTT Investigators Antiarrhythmic drug therapy in the Multicenter UnSustained Tachycardia Trial (MUSTT): drug testing and as-treated analysis. J Am Coll Car-diol 2001;38:344-51.Lechat P., Packer M., Chalon S. et al. Clinical effects of β-adrenergic blockade in chronic heart failure. A meta-analysis of double-blind, placebo-controlled, randomized trials. Circulation 1998;98:1184-91.Lechat P., Packer M., Chalon S. et al. Clinical effects of β-adrenergic blockade in chronic heart failure. A meta-analysis of double-blind, placebo-controlled, randomized trials. Circulation 1998;98:1184-91.Brophy J.M., Joseph L., Rouleau J.L. β-blockers in congestive heart failure. Ann Intern Med 2001;134: 550–60.Brophy J.M., Joseph L., Rouleau J.L. β-blockers in congestive heart failure. Ann Intern Med 2001;134: 550–60.Lee S., Spencer A. Beta-blockers to reduce mortality in patients with systolic dysfunction: a meta-analysis. J Fam Pract 2001;50:499-504.Lee S., Spencer A. Beta-blockers to reduce mortality in patients with systolic dysfunction: a meta-analysis. J Fam Pract 2001;50:499-504.Cleophas T.J., Zwinderman A.H. Beta-blockers and heart failure: meta-analysis of mortality trials. Int J Clin Pharmacol Ther 2001;39:383-88.Cleophas T.J., Zwinderman A.H. Beta-blockers and heart failure: meta-analysis of mortality trials. Int J Clin Pharmacol Ther 2001;39:383-88.Hjalmarson A. Effects of beta blockade on sudden cardiac death during acute myocardial infarction and the postinfarction period. Am J Cardiol 1997;80(9B):35J-39J.Hjalmarson A. Effects of beta blockade on sudden cardiac death during acute myocardial infarction and the postinfarction period. Am J Cardiol 1997;80(9B):35J-39J.Kuleshova E.V. What does provide a clinical efficacy of metoprolol? Rational Pharmacother Card 2010;6(3):370-375. Russian (Кулешова Э.В. Что обеспечивает клиническую эффективность метопролола? РФК 2010;6(3):370-75).Kuleshova E.V. What does provide a clinical efficacy of metoprolol? Rational Pharmacother Card 2010;6(3):370-375. Russian (Кулешова Э.В. Что обеспечивает клиническую эффективность метопролола? РФК 2010;6(3):370-75).COMMIT collaborative group. Addition of clopidogrel to aspirin in 45 852 patients with acute myocardial infarction: randomised, placebo-controlled trial. Lancet 2005;366:1607-21.COMMIT collaborative group. Addition of clopidogrel to aspirin in 45 852 patients with acute myocardial infarction: randomised, placebo-controlled trial. Lancet 2005;366:1607-21.Bunin Yu.A. The possibilities of antiarrhythmic therapy in primary prevention of death in patients with ventricular arrhythmias. Rational Pharmacother Card 2010;6(6):870-875. Russian (Бунин Ю.А. Возможности антиаритмической терапии в первичной профилактике смерти у больных с желудочковыми аритмиями. РФК 2010;6(6):870-75).Bunin Yu.A. The possibilities of antiarrhythmic therapy in primary prevention of death in patients with ventricular arrhythmias. Rational Pharmacother Card 2010;6(6):870-875. Russian (Бунин Ю.А. Возможности антиаритмической терапии в первичной профилактике смерти у больных с желудочковыми аритмиями. РФК 2010;6(6):870-75).Priori S.G., Zipes D.P. Sudden cardiac death. Malden, MA: Blackwell Publishing; 2006.Priori S.G., Zipes D.P. Sudden cardiac death. Malden, MA: Blackwell Publishing; 2006.

The authors declare that there are no conflicts of interest present.