PREDICTION OF MORTALITY IN PATIENTS AWAITING CARDIAC TRANSPLANTATION - INCREASED RISK OF SUDDEN-DEATH IN ISCHEMIC COMPARED TO IDIOPATHIC DILATED CARDIOMYOPATHY

A major problem in cardiac transplantation is the death of candidates due to the increasing shortage of donors and the consequent longer wai ting periods. To determine whether clinical markers for death could be identified in these patients; 168 adult candidates with heart failure (NYHA class III and IV) listed between August 1987 and December 1989 were analyzed. There were 104 patients with ischemic cardiomyopathy (I SCM) and 64 with idiopathic dilated cardiomyopathy (IDCM). Transplanta tion was performed in 93 patients (55%). Actuarial 1 year survival was 61% in the ISCM group and 78% in the IDCM group (P = NS). Freedom fro m sudden death at one year was significantly lower in the ISCM group ( 73%) than in the IDCM group (96%) (P <0.01). The rate of patients who did not die from terminal myocardial failure was 83% in the ISCM group and 81% in the IDCM group (P = NS). There were no significant differe nces between the two groups in right atrial, pulmonary artery, and pul monary wedge pressures, transpulmonic pressure gradient, pulmonary vas cular resistance, cardiac index, and ejection fraction. We conclude th at candidates for cardiac transplantation with ISCM are at higher risk for sudden death during the first year on the waiting list than patie nts with IDCM. These results warrant consideration of aggressive arrhy thmia control measures, including an automatic implantable defibrillat or, to ''bridge'' these high risk patients to transplantation.