Sudden and/or arrhythmic death (SAD), which typically results from lethal ventricular arrhythmias (ventricular tachycardia and ventricular fibrillation, VT/VF) in the setting of coronary heart disease (CHD), afflicts an estimated 310,000 persons annually in the United States. Reductions in SAD have continued to lag those observed for other coronary heart disease (CHD) outcomes despite advances in resuscitation therapies and the use of implantable cardioverter-defibrillators (ICDs). Current approaches to SAD prevention remain centered on placing ICDs in patients with left ventricular ejection fraction (LVEF) <30-35% – even though the majority of SAD occurs in the setting of LVEF >30-35%. In effect, the proportionately larger segment of the at-risk population has been understudied and thus undertreated. Despite this unmet need, there remain very few, if any, prospective studies examining SAD risk prediction in individuals with CHD and LVEF >30-35% over a long enough time horizon where ICD therapy might be cost-effective. For this very reason, the PRE- DETERMINE Cohort Study was intentionally designed to address this scientific gap and prospectively study clinically relevant approaches to SAD risk prediction in CHD patients with LVEF >30-35%. In this application, we propose to leverage the originally NHLBI-funded base cohort resource to continue adjudication of accruing SAD and VT/VF events, in addition to competing causes of death, to attain 10+ years of endpoint adjudication to enable the development and validation of multi-marker SAD risk prediction models based on combinations of multi-dimensional clinical, ECG, imaging, biomarker, and genetic data generated in this unique multicenter cohort of 5761 CHD patients. We will also leverage the base cohort to interrogate novel fatty acid derived eicosanoids and putative arrhythmia modulating proteomic analytes in relation to risk for SAD and competing causes of mortality in patients with CHD. Novel methods of competing r