Book Review

Sudden Cardiac Death

N Engl J Med 1995; 332:756March 16, 1995

Article

Sudden Cardiac Death
Revised edition. By Sidney Goldstein, Antonio Bayés-de-Luna, and J. Guindo-Soldevila. 343 pp. Armonk, N.Y., Futura, 1994. $68. ISBN: 0-87993-589-8

Two decades separate Dr. Sidney Goldstein's first edition of this book, called Sudden Death and Coronary Heart Disease, and the current version, entitled Sudden Cardiac Death. He has been joined in the new book by two Spanish cardiologists who, like him, are active investigators in the field. Of the 15 chapters in the first edition, 12 remain intact, a fitting testament to the well-organized format of the original version. The seven new chapters deal with sudden death in relation to diseases other than coronary heart disease — hence, the change in the title of the book. This diverse group of conditions includes long-QT syndromes, preexcitation syndromes, valvular and congenital heart disease, and the cardiomyopathies. They receive succinct coverage, with an emphasis on therapy where possible. There is a short discussion of the highly publicized issue of sudden death among athletes. It is to the authors' credit that they introduce the new subjects without minimizing the overwhelming priority of sudden death from coronary heart disease.

Anyone undertaking a review of sudden death from coronary heart disease must decide whether to emphasize the success of efforts to diminish the toll or the huge number of deaths the disease continues to exact. There were 511,000 deaths from coronary heart disease reported in the United States in 1988, at least 50 percent of which were probably sudden. However, the age-adjusted mortality rate for coronary heart disease fell from 226 deaths per 100,000 population in 1950 to 124 per 100,000 in 1987. The authors have done a masterly job of organizing the material in a way that stresses the duality of the success story and the huge challenge still to be faced.

This book is truly a paean to the vast efforts of the past 20 years, in the form of the large, randomized, multicenter clinical trials whose acronyms and findings have become so much a part of contemporary cardiology. Conducted not only in the United States but also internationally, these studies have covered the entire spectrum of treatment, from primary prevention to secondary prevention after coronary heart disease has become clinically manifest. The treatment tools include diet, drugs, surgery, and electronic devices, and it is gratifying to see that each category has had its share of successes.

Unfortunately, there are disappointments. The authors discuss fully the adverse outcomes of the Cardiac Arrhythmia Suppression Trial (CAST) of antiarrhythmic drugs. The inclusion of trials that do not use sudden death as an end point is justified by the reasonable presumption that any significant reduction in cardiac mortality over a long period would probably be due in part to a reduction in the number of sudden deaths.

A valuable feature of the book is the many lucid tables and figures that aid the reader traversing this huge terrain. One is also aware of the reasoned commentary throughout.

The authors are to be congratulated on assembling so much material on sudden cardiac death in so compact a book. It should be valuable to a wide variety of readers in the cardiologic and general medical communities, as well as to those in the allied health professions who confront this condition.

William Ruberman, M.D.
New York University Medical School, New York, NY 10016