A NEW SYSTEM FOR CLASSIFICATION OF CARDIAC DEATH AS ARRHYTHMIC, ISCHEMIC, OR DUE TO MYOCARDIAL PUMP FAILURE

Existing classifications of cardiac death fail to Incorporate current understanding of the pathophysiology of sudden cardiac death. We devel oped a new scheme for classifying cardiac death that defines 3 categor ies of underlying mechanism: primary arrhythmia, acute myocardial isch emia/infarction, and myocardial pump failure, Using this new system, w e classified the mechanism of 106 definite cardiac deaths from the Rec urrent Coronary Prevention Project. Fifty deaths (47%) were classified as arrhythmic, 46 (43%) as ischemic, and 9 (8%) as due to myocardial pump failure (1 death was not classifiable). All 36 witnessed arrhythm ic deaths were sudden and 8 of 9 witnessed myocardial pomp failure dea ths were nonsudden. The 38 witnessed ischemic deaths were split evenly between sudden and nonsudden, Interrater agreement for the classifica tion of mechanism was 100%, This classification scheme, if validated i n subsequent studies, will provide a useful algorithm for classifying deaths by underlying mechanism.