Key result
Implantable cardioverter-defibrillators added to optimized pharmacological therapy decrease the risk of overall and sudden cardiac death mortality in patients with chronic stable coronary artery disease.
Why the study?
Does optimized pharmacological therapy and ICD implantation reduce sudden cardiac death and all-cause mortality in patients with coronary artery disease?
Does optimized pharmacological therapy and ICD implantation reduce sudden cardiac death and all-cause mortality in patients with coronary artery disease?
This review highlights that while optimized medical therapy and ICDs prevent sudden cardiac death in high-risk CAD patients, ICDs are most beneficial in chronic stable CAD and less effective early after myocardial infarction due to competing non-arrhythmic risks.
May support ICD addition to medical therapy in stable CAD; leaves open optimal post-MI timing due to competing risks.
Sudden cardiac death (SCD), presumably because of ventricular tachyarrhythmias, remains one of the major challenges of contemporary cardiology. Major randomized controlled trials conducted in patients with coronary artery disease (CAD) with the aim of primary prevention of SCD are providing insights. Several large-scale studies have demonstrated that treatment with beta-blockers, angiotensin-converting enzyme inhibitors, aldosterone antagonists, and statins results not only in a reduction in all-cause mortality but specifically also in SCD. On top of this optimized pharmacological therapy, implantable cardioverter-defibrillators (ICD) further decrease the risk of overall and SCD mortality in carefully selected patient groups. The sum of these trials indicates, however, that the benefit associated with ICD therapy is most prominent in patients with chronic stable CAD. In contrast, patients early after myocardial infarction derive less benefit from ICD treatment, presumably because of a high competing risk of non-arrhythmic cardiovascular death. Optimized pharmacological therapy, together with the ICD, can substantially improve the prognosis of high-risk CAD patients.
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Richter et al. (2005) conducted a review in Sudden cardiac death and coronary artery disease. Optimized pharmacological therapy and implantable cardioverter-defibrillators (ICD) was evaluated on All-cause mortality and sudden cardiac death. Implantable cardioverter-defibrillators added to optimized pharmacological therapy decrease the risk of overall and sudden cardiac death mortality in patients with chronic stable coronary artery disease.
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