Prior revascularization in patients with secondary prevention ICDs was associated with decreased mortality (HR 0.46; 95% CI 0.24-0.85; p=0.015), with no association seen in primary prevention.
Cohort (n=606)
Does prior revascularization reduce mortality and ventricular arrhythmia in patients with ischemic cardiomyopathy undergoing ICD implantation?
Prior revascularization is associated with reduced mortality and a trend toward fewer ventricular arrhythmias in patients receiving secondary prevention ICDs, but not primary prevention ICDs.
Effect estimate: HR 0.46 (95% CI 0.24, 0.85)
p-value: p=0.015
BACKGROUND: There is clear evidence that patients with prior myocardial infarction and a reduced ejection fraction benefit from implantation of a cardioverter-defibrillator (ICD). It is unclear whether this benefit is altered by whether or not revascularization is performed prior to ICD implantation. METHODS: This was a retrospective cohort study following patients who underwent ICD implantation from 2002 to 2014. Patients with ischemic cardiomyopathy and either primary or secondary prevention ICDs were selected for inclusion. Using the electronic medical record, cardiac catheterization data, revascularization status (percutaneous coronary intervention or coronary bypass surgery) were recorded. The outcomes were mortality and ventricular arrhythmia. RESULTS: There were 606 patients included in the analysis. The mean age was 66.3 ± 10.1 years, 11.9% were women, and the mean LVEF was 30.5 ± 12.0, 58.9% had a primary indication for ICD, 82.0% of the cohort had undergone coronary catheterization prior to ICD implantation. In the overall cohort, there were fewer mortality and ventricular arrhythmia events in patients who had undergone prior revascularization. In patients who had an ICD for secondary prevention, revascularization was associated with a decrease in mortality (HR 0.46, 95% CI (0.24, 0.85) p = 0.015), and a trend towards fewer ventricular arrhythmia (HR 0.62, 95% CI (0.38, 1.00) p = 0.051). There was no association between death or ventricular arrhythmia with revascularization in patients with primary prevention ICDs. CONCLUSION: Revascularization may be beneficial in preventing recurrent ventricular arrhythmia, and should be considered as adjunctive therapy to ICD implantation to improve cardiovascular outcomes.
Alkharaza et al. (Wed,) conducted a cohort in Ischemic cardiomyopathy requiring ICD (n=606). Prior revascularization (PCI or CABG) vs. No prior revascularization was evaluated on Mortality (HR 0.46, 95% CI 0.24, 0.85, p=0.015). Prior revascularization in patients with secondary prevention ICDs was associated with decreased mortality (HR 0.46; 95% CI 0.24-0.85; p=0.015), with no association seen in primary prevention.