Background Previous studies have identified multiple risk factors that are associated with total cardiac mortality. Nevertheless, identifying specific factors that distinguish patients at risk of arrhythmic death versus heart failure could better target patients likely to benefit from implantable cardiac defibrillators (ICDs), which have no impact on non-sudden cardiac death (NSCD). Methods and Results We performed a pilot competing risks analysis of the NIH-sponsored PAREPET trial (Prediction of ARrhythmic Events with Positron Emission Tomography). Death from cardiac causes was ascertained in subjects with ischemic cardiomyopathy (n=204) eligible for an ICD for the primary prevention of sudden cardiac arrest (SCA) after baseline clinical evaluation and imaging at enrollment (PET and 2D-echo). Mean age was 67±11 years with an EF of 27±9%, and 90% were male. Over 4.1 years of follow-up, there were 33 SCAs (arrhythmic death or ICD discharge for ventricular fibrillation or ventricular tachycardia >240 bpm) and 36 NSCDs. SCA was correlated with a greater volume of denervated myocardium (defect of the PET norepinephrine analog 11C-hydroxyephedrine), lack of angiotensin inhibition therapy, elevated B-type natriuretic peptide, and larger LV end-diastolic volume index (LVEDVI). In contrast, NSCD was associated with a higher resting heart rate, older age, elevated creatinine, larger left atrial volume index, and larger LVEDVI. Conclusions Distinct clinical, laboratory and imaging variables are associated with cause-specific cardiac mortality in primary prevention candidates with ischemic cardiomyopathy. If prospectively validated, these multi-variable associations may help target specific therapies to those at greatest risk of sudden and non-sudden cardiac death.