title: Impact of revascularization in patients with sustained ventricular arrhythmias, prior myocardial infarction, and preserved left ventricular ejection fraction.
abstract: The impact of revascularization on recurrent ventricular arrhythmias (VAs) in patients with coronary artery disease and relatively preserved left ventricular ejection fraction (LVEF) is unknown.
  
  
  
  The purpose of this study was to determine the impact of revascularization on recurrent VAs or death.
  
  
  
  A cohort study was conducted on consecutive patients with prior myocardial infarction and LVEF ≥40% presenting with a first clinical sustained VA in the absence of an acute coronary syndrome. The impact of revascularization on recurrent VAs and all-cause mortality was assessed.
  
  
  
  A total of 274 patients (mean age 66.1 ± 9.7 years, 85.4% male, mean LVEF 48.3% ± 7.2%) were included in the study. Eight-eight patients (32.1%) underwent coronary revascularization. During mean follow-up of 6.2 ± 5.1 years, 140 (51.1%) died or had recurrent sustained VAs or appropriate implantable-cardioverter defibrillator therapy. Revascularization was not associated with a significantly lower rate of recurrent VAs or death (multivariable hazard ratio [HR] 0.86, 95% confidence interval [CI] 0.60-1.24, P = .43) regardless of whether it was complete or incomplete (HR 0.65, 95% CI 0.25-1.69, P = .37) or was performed by percutaneous or surgical means (HR 1.02, 95% CI 0.53-1.94, P = .96). An implantable-cardioverter defibrillator was associated with a significant reduction in mortality (HR 0.23, 95% CI 0.09-0.55, P = .001).
  
  
  
  Patients with prior myocardial infarction and LVEF ≥40% who present with sustained VAs in the absence of an acute coronary syndrome remain at high risk for recurrent VAs and all-cause death. Coronary revascularization does not systemically mitigate this risk.
authors.affiliation: Department of Electrophysiology, Montreal Heart Institute, Université de Montréal, Montreal, Canada.
authors.forename: Blandine
authors.initials: B
authors.lastname: Mondésert
authors.affiliation: Department of Electrophysiology, Montreal Heart Institute, Université de Montréal, Montreal, Canada; Montreal Health Innovations Coordinating Center (MHICC), Montreal Canada.
authors.forename: Paul
authors.initials: P
authors.lastname: Khairy
authors.affiliation: Lakeshore General Hospital.
authors.forename: Gernot
authors.initials: G
authors.lastname: Schram
authors.affiliation: Montreal Health Innovations Coordinating Center (MHICC), Montreal Canada.
authors.forename: Azadeh
authors.initials: A
authors.lastname: Shohoudi
authors.affiliation: Department of Electrophysiology, Montreal Heart Institute, Université de Montréal, Montreal, Canada.
authors.forename: Mario
authors.initials: M
authors.lastname: Talajic
authors.affiliation: Department of Electrophysiology, Montreal Heart Institute, Université de Montréal, Montreal, Canada.
authors.forename: Jason G
authors.initials: JG
authors.lastname: Andrade
authors.affiliation: Department of Electrophysiology, Montreal Heart Institute, Université de Montréal, Montreal, Canada.
authors.forename: Marc
authors.initials: M
authors.lastname: Dubuc
authors.affiliation: Department of Electrophysiology, Montreal Heart Institute, Université de Montréal, Montreal, Canada.
authors.forename: Peter G
authors.initials: PG
authors.lastname: Guerra
authors.affiliation: Department of Electrophysiology, Montreal Heart Institute, Université de Montréal, Montreal, Canada.
authors.forename: Laurent
authors.initials: L
authors.lastname: Macle
authors.affiliation: Department of Electrophysiology, Montreal Heart Institute, Université de Montréal, Montreal, Canada.
authors.forename: Denis
authors.initials: D
authors.lastname: Roy
authors.affiliation: Department of Electrophysiology, Montreal Heart Institute, Université de Montréal, Montreal, Canada.
authors.forename: Katia
authors.initials: K
authors.lastname: Dyrda
authors.affiliation: Department of Electrophysiology, Montreal Heart Institute, Université de Montréal, Montreal, Canada.
authors.forename: Bernard
authors.initials: B
authors.lastname: Thibault
authors.affiliation: Centre Hospitalier Régional de Trois-Rivières.
authors.forename: Miguel
authors.initials: M
authors.lastname: Barrero
authors.affiliation: Centre Hospitalier Régional de Trois-Rivières.
authors.forename: Ariel
authors.initials: A
authors.lastname: Diaz
authors.affiliation: Centre Hospitalier Régional de Lanaudière.
authors.forename: Simon
authors.initials: S
authors.lastname: Kouz
authors.affiliation: Hôpital Régional de Saint-Jérome.
authors.forename: Serge
authors.initials: S
authors.lastname: McNicoll
authors.affiliation: Hôpital Pierre-Boucher, Longueuil, Canada.
authors.forename: Dominika
authors.initials: D
authors.lastname: Nowakowska
authors.affiliation: Department of Electrophysiology, Montreal Heart Institute, Université de Montréal, Montreal, Canada. Electronic address: lena.rivard@umontreal.ca.
authors.forename: Léna
authors.initials: L
authors.lastname: Rivard
mesh_terms: D000368:Aged; D002170:Canada / Q000453:epidemiology; D003324:Coronary Artery Disease / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology; D017147:Defibrillators, Implantable / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000503:physiopathology / Q000601:surgery; D009204:Myocardial Revascularization / Q000009:adverse effects / Q000379:methods; D010043:Outcome and Process Assessment, Health Care; D012008:Recurrence; D018570:Risk Assessment; D013318:Stroke Volume / Q000502:physiology; D016019:Survival Analysis; D017180:Tachycardia, Ventricular / Q000150:complications / Q000175:diagnosis / Q000401:mortality; D016277:Ventricular Function, Left / Q000502:physiology
keywords: Coronary artery disease; Implantable cardioverter-defibrillator; Ventricular tachycardia