title: Improved survival of patients with coronary artery disease and low ejection fraction with ICD implantation versus conventional therapy in a real world survey.
abstract: BACKGROUND
  Coronary artery disease (CAD) is associated with an increased risk for sudden cardiac death. Randomized controlled trials have shown that implantable cardioverter defibrillators (ICD) improve life expectancy unless they are implanted within the first days after an acute myocardial infarction and guidelines recommend their use. We aimed to validate that these results also apply to patients of a typical community hospital in Germany.
  
  
  METHODS
  This was a retrospective analysis of patients undergoing coronary angiography in the Lippe-Detmold Hospital between 2003 and 2006. They had to have significant CAD and an ejection fraction (EF) ≤ 35% and no acute myocardial infarction within 28 days of implantation and no history of ventricular fibrillation.
  
  
  RESULTS
  213 patients were included; 70 of which received an ICD. Patients with an ICD implantation were younger (64.8 ± 9.9 vs. 67.9 ± 9.8 years; p = 0.034), had single vessel CAD more frequently (22.9 vs. 11.2%; p = 0.025) and a lower EF (26.7 ± 6.3 vs. 29.1 ± 4.6%; p = 0.006). Hospital readmissions were comparable between the ICD and the control group (68.6 vs. 72.0%; p = 0.602). ICD therapy was associated with a considerable survival benefit compared to conventional therapy (HR 0.52; 95%CI 0.29-0.93; p = 0.027) in a Cox-Proportional Hazards Regression analysis.
  
  
  CONCLUSIONS
  Appreciating the potential limitations of retrospective studies, we found that ICD use was associated with improved survival in patients with significant CAD and an EF <= 35% typical for a large tertiary hospital.
authors: Institut für Pharmakologie und präventive Medizin, Mahlow, Germany.
authors: Timo
authors: T
authors: Aschenbrenner
authors: Johannes
authors: J
authors: Brockmeier
authors: Peter
authors: P
authors: Bramlage
authors: Rolf
authors: R
authors: Fimmers
authors: Alessandro
authors: A
authors: Cuneo
authors: Stefan
authors: S
authors: Hochreuther
authors: Claudia
authors: C
authors: Zemmrich
authors: Ulrich
authors: U
authors: Tebbe
mesh_terms: D000368:Aged; D002316:Cardiotonic Agents / Q000627:therapeutic use*; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D017147:Defibrillators, Implantable; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission; D012189:Retrospective Studies; D013318:Stroke Volume; D016019:Survival Analysis; D062606:Tertiary Care Centers
chemical_list: D002316:Cardiotonic Agents