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The Primary Prevention of Sudden Death in Patients with Coronary Artery Disease

Michael J. Domanski, MD; and Alfred E. Buxton, MD
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National Heart, Lung, and Blood Institute, Bethesda, MD 20892. Temple University School of Medicine, Philadelphia, PA 19140. Requests for Reprints: Michael J. Domanski, MD, Clinical Trials Branch, National Heart, Lung, and Blood Institute, Bethesda, MD 20892.

Copyright 2004 by the American College of Physicians

Ann Intern Med. 1993;119(12):1218-1220. doi:10.7326/0003-4819-119-12-199312150-00011
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About 300 000 people suffer sudden cardiac arrest in the United States each year [1]. In those who recover, the risk for recurrent cardiac arrest approaches 30% during the next 2 years when the initial arrest was not associated with acute myocardial infarction [23]. This risk has increased interest in secondary prevention, that is, in preventing subsequent cardiac arrest. Unfortunately, only a few persons who have an out-of-hospital cardiac arrest survive to hospital discharge [34]. Focused attempts at resuscitation by community-based emergency teams result in survival rates of 14% to 16% of cardiac arrests [34]. Because of the continuing dismal prognosis, the effect of secondary prevention, no matter how effective, is limited. Attention is now focused on primary prevention (preventing an initial episode of cardiac arrest). For this maneuver to substantially reduce mortality, however, those persons in the population who are at high risk for cardiac arrest must be identifiable, and effective interventions to prevent cardiac arrest must be available.

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