Effect of elapsed time from coronary revascularization to implantation of a cardioverter defibrillator on long-term survival in the MADIT-II trial

Alon Barsheshet*, Ilan Goldenberg, Arthur J. Moss, David T. Huang, Wojciech Zareba, Scott McNitt, Helmut U. Klein, Victor Guetta

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

24 Scopus citations

Abstract

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.

Original languageEnglish
Pages (from-to)1237-1242
Number of pages6
JournalJournal of Cardiovascular Electrophysiology
Volume22
Issue number11
DOIs
StatePublished - Nov 2011
Externally publishedYes

Keywords

  • coronary revascularization
  • implantable cardioverter defibrillator
  • sudden death
  • ventricular fibrillation
  • ventricular tachycardia

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