Improved survival of patients with coronary artery disease and low ejection fraction with ICD implantation versus conventional therapy in a real world survey

BMC Research Notes

Ulrich Tebbe¹  Claudia Zemmrich²  Stefan Hochreuther¹  Alessandro Cuneo⁴  Rolf Fimmers³  Peter Bramlage²  Johannes Brockmeier¹  Timo Aschenbrenner¹ 

[1] Department I - Cardiology, Angiology, Intensive Care Medicine, Klinikum Lippe-Detmold, Röntgenstrasse 18, 32756, Detmold, Germany;Institut für Pharmakologie und präventive Medizin, Mahlow, Germany;Department of Biometry and Medical Statistics, University of Bonn, Bonn, Germany;Abteilung für Kardiologie, Asklepios Klinik St-Georg, Hamburg, Germany

关键词: Myocardial infarction;    Cohort study;    Implantable cardioverter defibrillator;   

Others  :  1166072
DOI  :  10.1186/1756-0500-5-382

 received in 2012-01-19, accepted in 2012-07-27,  发布年份 2012

【 摘 要 】

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.

【 授权许可】

   
2012 Aschenbrenner et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1 Probability of survival: 0.0; 0.2; 0.4; 0.6; 0.8; 1.0.

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