title: Natural History and Implantable Cardioverter-Defibrillator Implantation After Revascularization for Stable Coronary Artery Disease With Depressed Ejection Fraction.
abstract: BACKGROUND
  Following revascularization, most payors require 3 months of medical therapy, followed by left ventricular ejection fraction (LVEF) reassessment, before implantable cardioverter-defibrillator (ICD) implantation possibly contributing to incomplete follow-up and suboptimal utilization of ICD therapy. The natural history of these patients, and their fate regarding ICD implantation, is unknown.
  
  
  OBJECTIVE
  We hypothesized that a waiting period after revascularization for stable CAD results in missed opportunities to provide care with regard to ICD implantation.
  
  
  METHODS
  We followed patients with LVEF ≤ 35% and no ICD who underwent revascularization (coronary artery bypass grafting [CABG] or percutaneous coronary intervention [PCI]) for stable CAD. Follow-up used chart review and scripted telephone interviews.
  
  
  RESULTS
  Among 3164 revascularized patients (2198 [69%] PCI, 966 [31%] CABG), only 62 (2%; 33 [53%] male, age 67 ± 12 y, LVEF 28% ± 6%) had stable CAD, depressed LVEF, and no ICD. Over 35 ± 19 months, 35 (56%) of these 62 patients were no longer candidates for ICD based on improved LVEF, 14 (23%) received an ICD, 5 (8%) declined ICD despite physician recommendation, 3 (5%) were not offered ICD despite continued eligibility, 2 (3%) died, 1 (2%) was not a candidate due to substance abuse, and 1 (2%) had ICD implantation temporarily deferred. Only 1 (2%) was lost to follow-up.
  
  
  CONCLUSIONS
  Following revascularization for stable CAD with depressed LVEF, ≥50% of patients' ventricular function improved enough to make ICD implantation unnecessary. A waiting period after revascularization prior to ICD implantation appears appropriate and does not significantly negatively impact follow-up or the rate of appropriate ICD implantation.
authors.affiliation: John Ochsner Heart and Vascular Institute, Ochsner Medical Center, New Orleans, Louisiana.
authors.forename: Geoffrey F
authors.initials: GF
authors.lastname: Lewis
authors.affiliation: John Ochsner Heart and Vascular Institute, Ochsner Medical Center, New Orleans, Louisiana.
authors.forename: Adam C
authors.initials: AC
authors.lastname: Harless
authors.affiliation: Department of Psychiatry, Ochsner Medical Center, New Orleans, Louisiana.
authors.forename: Lauren
authors.initials: L
authors.lastname: Vazquez
authors.affiliation: John Ochsner Heart and Vascular Institute, Ochsner Medical Center, New Orleans, Louisiana.
authors.forename: Freddy M
authors.initials: FM
authors.lastname: Abi-Samra
authors.affiliation: John Ochsner Heart and Vascular Institute, Ochsner Medical Center, New Orleans, Louisiana.
authors.forename: Michael L
authors.initials: ML
authors.lastname: Bernard
authors.affiliation: John Ochsner Heart and Vascular Institute, Ochsner Medical Center, New Orleans, Louisiana.
authors.forename: Sammy
authors.initials: S
authors.lastname: Khatib
authors.affiliation: John Ochsner Heart and Vascular Institute, Ochsner Medical Center, New Orleans, Louisiana.
authors.forename: Glenn M
authors.initials: GM
authors.lastname: Polin
authors.affiliation: John Ochsner Heart and Vascular Institute, Ochsner Medical Center, New Orleans, Louisiana.|Ochsner Clinical School, Queensland University School of Medicine, Ochsner Clinic Foundation, New Orleans, Louisiana.
authors.forename: Daniel P
authors.initials: DP
authors.lastname: Morin
mesh_terms: D000368:Aged; D003324:Coronary Artery Disease / Q000150:complications / Q000628:therapy*; D017147:Defibrillators, Implantable / Q000009:adverse effects / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization / Q000379:methods*; D012307:Risk Factors; D013318:Stroke Volume; D013997:Time Factors; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000628:therapy*