Factors determining long-term outcomes and survival in patients with coronary artery disease and ventricular tachyarrhythmias: a single center experience.
A Single-Center Experience. The influence, after ICD implantation, of concomitant CABG, angioplasty, and other antiischemic therapeutic interventions, like treatment with beta-blockers, on outcome and mortality of patients with VT or VF due to CAD remains uncertain. The univariate and multivariate risks of recurrence of ventricular arrhythmias requiring ICD interventions or death associated with baseline clinical and functional variables were studied in 160 consecutive patients with CAD of whom 30 underwent CABG or angioplasty at < or = 2 weeks before ICD implantation. ICD interventions occurred in 98 (61%) patients over a mean follow-up of 1,065 days. In univariate and multivariate analysis, VT as the presenting arrhythmia was the only clinical factor predictive of recurrences. Treatment with beta-blockers at hospital discharge reduced the probability of recurrences. Kaplan-Meier analysis confirmed the effect of beta-blockers (P < 0.005) and of VT as the presenting arrhythmia (P < 0.01). Overall mortality was 61% (29/160). In multivariate analysis a low ejection fraction (< or = 0.20) and omission of angiotensin-converting enzyme inhibitors at discharge were associated with excess mortality. In Kaplan-Meier analysis, a low ejection fraction (borderline between 0.30 and 0.21, significant < 0.21) was the single predictor of mortality. Revascularization by CABG or angioplasty had no influence on ventricular arrhythmia recurrences or survival. During long-term follow-up, VT as the presenting arrhythmia and the omission of beta-blocker therapy were associated with excess recurrences of ventricular arrhythmias after ICD implantation. In contrast, survival depended primarily on left ventricular function at discharge. Revascularization did not prevent recurrences of arrhythmias and had no significant effect on survival in the small group of patients who underwent CABG or angioplasty.
De Sutter
J
J
Department of Cardiology, Ghent University Hospital, Ghent, Belgium.
Kazmierczak
J
J
Fonteyne
W
W
Tavernier
R
R
Jordaens
L J
LJ
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000150:complications* / Q000628:therapy; D017147:Defibrillators, Implantable; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D012008:Recurrence; D012307:Risk Factors; D013318:Stroke Volume; D015996:Survival Rate; D017180:Tachycardia, Ventricular / Q000150:complications* / Q000175:diagnosis; D016277:Ventricular Function, Left / Q000187:drug effects
D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors