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- Title
Effect of Elapsed Time From Coronary Revascularization to Implantation of a Cardioverter Defibrillator on Long-Term Survival in the MADIT-II Trial.
- Authors
BARSHESHET, ALON; GOLDENBERG, ILAN; MOSS, ARTHUR J.; HUANG, DAVID T.; ZAREBA, WOJCIECH; McNITT, SCOTT; KLEIN, HELMUT U.; GUETTA, VICTOR
- 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. (J Cardiovasc Electrophysiol, Vol. pp. 1-6)
- Subjects
CARDIAC arrest prevention; VENTRICULAR fibrillation treatment; VENTRICULAR tachycardia; HEART ventricle diseases; ANALYSIS of variance; CHI-squared test; FISHER exact test; LEFT heart ventricle; IMPLANTABLE cardioverter-defibrillators; MULTIVARIATE analysis; MYOCARDIAL revascularization; HEALTH outcome assessment; STATISTICS; SURVIVAL analysis (Biometry); TIME; TREATMENT effectiveness; PROPORTIONAL hazards models; DATA analysis software; THERAPEUTICS
- Publication
Journal of Cardiovascular Electrophysiology, 2011, Vol 22, Issue 11, p1237
- ISSN
1045-3873
- Publication type
Article
- DOI
10.1111/j.1540-8167.2011.02096.x