TY - JOUR
T1 - Effect of elapsed time from coronary revascularization to implantation of a cardioverter defibrillator on long-term survival in the MADIT-II trial
AU - Barsheshet, Alon
AU - Goldenberg, Ilan
AU - Moss, Arthur J.
AU - Huang, David T.
AU - Zareba, Wojciech
AU - McNitt, Scott
AU - Klein, Helmut U.
AU - Guetta, Victor
PY - 2011/11
Y1 - 2011/11
N2 - Coronary Revascularization and Long-Term Mortality in MADIT-II. Introduction: Coronary revascularization (CR) may reduce arrhythmia risk and improve long-term outcome in patients with left ventricular dysfunction. This study was designed to evaluate the effect of elapsed time from CR on long-term mortality and arrhythmic risk among patients who receive an implantable cardioverter defibrillator (ICD). Methods and Results: We evaluated the risk of 8-year mortality by elapsed time from CR to ICD implantation (categorized as: no CR; recent CR [<2 years]; or nonrecent CR [≥2 years], and assessed as a continuous measure) among 720 ICD recipients enrolled in the Multicenter Automatic Defibrillator Trial-II. At 8years of follow-up, patients who did not undergo CR and those who underwent nonrecent CR had significantly higher mortality rates than patients who underwent recent CR (54%, 54%, and 36%, respectively; P < 0.001). Multivariate analysis demonstrated that no- and nonrecent CR were associated with respective 48% (P = 0.022) and 67% (P < 0.001) increases in mortality risk compared with recent CR. Assessment of time from CR as a continuous measure showed that every year elapsed from CR was associated with an adjusted 6% increase in 8-year mortality (P < 0.001), and in respective 6% (P < 0.001) and 6% (P = 0.003) increased risk for in-trial appropriate ICD therapy of ventricular tachyarrhythmias and appropriate ICD shocks. Conclusions: We observed a direct relationship between elapsed time from CR and long-term mortality following ICD implantation. The favorable long-term effect on outcome of recent CR may be related to a time-dependent effect of CR on ventricular arrhythmic burden and the need for appropriate ICD shocks.
AB - Coronary Revascularization and Long-Term Mortality in MADIT-II. Introduction: Coronary revascularization (CR) may reduce arrhythmia risk and improve long-term outcome in patients with left ventricular dysfunction. This study was designed to evaluate the effect of elapsed time from CR on long-term mortality and arrhythmic risk among patients who receive an implantable cardioverter defibrillator (ICD). Methods and Results: We evaluated the risk of 8-year mortality by elapsed time from CR to ICD implantation (categorized as: no CR; recent CR [<2 years]; or nonrecent CR [≥2 years], and assessed as a continuous measure) among 720 ICD recipients enrolled in the Multicenter Automatic Defibrillator Trial-II. At 8years of follow-up, patients who did not undergo CR and those who underwent nonrecent CR had significantly higher mortality rates than patients who underwent recent CR (54%, 54%, and 36%, respectively; P < 0.001). Multivariate analysis demonstrated that no- and nonrecent CR were associated with respective 48% (P = 0.022) and 67% (P < 0.001) increases in mortality risk compared with recent CR. Assessment of time from CR as a continuous measure showed that every year elapsed from CR was associated with an adjusted 6% increase in 8-year mortality (P < 0.001), and in respective 6% (P < 0.001) and 6% (P = 0.003) increased risk for in-trial appropriate ICD therapy of ventricular tachyarrhythmias and appropriate ICD shocks. Conclusions: We observed a direct relationship between elapsed time from CR and long-term mortality following ICD implantation. The favorable long-term effect on outcome of recent CR may be related to a time-dependent effect of CR on ventricular arrhythmic burden and the need for appropriate ICD shocks.
KW - coronary revascularization
KW - implantable cardioverter defibrillator
KW - sudden death
KW - ventricular fibrillation
KW - ventricular tachycardia
UR - http://www.scopus.com/inward/record.url?scp=80755140162&partnerID=8YFLogxK
U2 - 10.1111/j.1540-8167.2011.02096.x
DO - 10.1111/j.1540-8167.2011.02096.x
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C2 - 21615813
AN - SCOPUS:80755140162
SN - 1045-3873
VL - 22
SP - 1237
EP - 1242
JO - Journal of Cardiovascular Electrophysiology
JF - Journal of Cardiovascular Electrophysiology
IS - 11
ER -