The effect of revascularization on mortality and risk of ventricular arrhythmia in patients with ischemic cardiomyopathy
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(2020) 20:455
RESEARCH ARTICLE
Open Access
The effect of revascularization on mortality and risk of ventricular arrhythmia in patients with ischemic cardiomyopathy Ahmad Alkharaza1, Mousa Al-Harbi2, Ihab El-sokkari1, Steve Doucette3, Ciorsti MacIntyre1, Christopher Gray1, Amir Abdelwahab1, John L. Sapp1, Martin Gardner1 and Ratika Parkash1*
Abstract 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. Keywords: Implantable cardioverter defibrillator, Coronary revascularization, Coronary artery disease (CAD), And ventricular arrhythmias
* Correspondence: [email protected] 1 Queen Elizabeth II Health Sciences Center, HI Site, 1796 Summer Street, Room 2501D, Halifax, Nova Scotia, Canada Full list of author information is available at the end of the article © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the arti
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