Predictors of Appropriate Implantable Cardioverter-Defibrillator Therapy During Long-Term Follow-up of Patients With Coronary Artery Disease

Abstract

SummaryIndications for implantable cardioverter defibrillators (ICDs) are expanding. Defining long-term predictors of ICD therapies might help to identify those patients who will benefit most from implantation of an ICD. The objective of this study was to examine longterm predictors of appropriate ICD therapy among patients with coronary disease at high risk of sudden cardiac death.An analysis of 245 patients with coronary disease, who had been implanted with an ICD for primary or secondary prevention of sudden cardiac death, was performed. Time to appropriate ICD therapy, defined as antitachycardia pacing or shock, was evaluated by the Kaplan-Meier method. Cox regression analysis was performed to determine hazard ratios for factors predicting appropriate ICD therapies.During a mean (SD) follow-up of 41 (33) months, 115 patients (53%) experienced appropriate ICD therapy. Independent predictors of appropriate ICD therapy included advanced age, left ventricular ejection fraction (LVEF) < 35%, and impaired renal function, with covariate-adjusted hazard ratios of 1.36 per 10 years (95% CI, 1.11 -1.66; P = 0.003), 1.78 (95% CI, 1.21 -2.63; P = 0.004), and 1.59 (95% CI, 1.00 -2.54; P = 0.050), respectively. Remote myocardial infarction (> 6 months prior to ICD implantation) was associated with higher probability of appropriate ICD therapy among patients with LVEF > 35% (adjusted HR 2.68 [95% CI, 1.05 -6.86; P = 0.04]), but not among patients with LVEF < 35% (adjusted HR 1.09 [95% CI, 0.58 -2.04; P = 0.79]).Left ventricular ejection fraction, advanced age, and renal impairment are long-term predictors of appropriate ICD therapy in patients with coronary disease at high risk of sudden cardiac death. Patients with an ejection fraction above 35% have few arrhythmic events early after the myocardial infarction but appropriate therapies become more frequent late after the myocardial infarction, possibly due to progression of the disease. (Int Heart J 2009; 50: 313-321)

Clinical Predictors of Recurrent Ventricular Arrhythmias in Secondary Prevention Implantable Cardioverter Defibrillator Recipients With Coronary Artery Disease ― Lower Left Ventricular Ejection Fraction and Incomplete Revascularization ―

“…As in some previous studies, [16][17][18] in the present study lower LVEF was a strong predictor of ICD-Tx for VA. LVEF is the well-known gold standard risk stratification for the occurrence of life-threatening VA, and ICD is also known to exhibit a particularly high SCD preventive effect in patients with LVEF <30-35%. 1,2 Similarly, in the present study the appropriate ICD-Tx rate in patients with LVEF <35% was significantly higher than that in patients with LVEF ≥35%.…”

Elevated γ-glutamyltransferase in implantable cardioverter defibrillator patients

“…Accordingly, several studies suggest that patients with advanced kidney disease have little benefi t from prophylactic ICD therapy and suff er from higher device com- plication rates such as infection [4,[17][18][19]. On the other hand, renal insuffi ciency was found to be a predictor of appropriate ICD therapy [20,21]. Considering these possible benefi ts and risks, further studies are needed to assess the potential impact of ICD therapy in patients with chronic kidney disease.…”