Blandine Mondésert1, Paul Khairy2, Gernot Schram3, Azadeh Shohoudi4, Mario Talajic1, Jason G Andrade1, Marc Dubuc1, Peter G Guerra1, Laurent Macle1, Denis Roy1, Katia Dyrda1, Bernard Thibault1, Miguel Barrero5, Ariel Diaz5, Simon Kouz6, Serge McNicoll7, Dominika Nowakowska8, Léna Rivard9. 1. Department of Electrophysiology, Montreal Heart Institute, Université de Montréal, Montreal, Canada. 2. Department of Electrophysiology, Montreal Heart Institute, Université de Montréal, Montreal, Canada; Montreal Health Innovations Coordinating Center (MHICC), Montreal Canada. 3. Lakeshore General Hospital. 4. Montreal Health Innovations Coordinating Center (MHICC), Montreal Canada. 5. Centre Hospitalier Régional de Trois-Rivières. 6. Centre Hospitalier Régional de Lanaudière. 7. Hôpital Régional de Saint-Jérome. 8. Hôpital Pierre-Boucher, Longueuil, Canada. 9. Department of Electrophysiology, Montreal Heart Institute, Université de Montréal, Montreal, Canada. Electronic address: lena.rivard@umontreal.ca.
Abstract
BACKGROUND: 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. OBJECTIVE: The purpose of this study was to determine the impact of revascularization on recurrent VAs or death. METHODS: 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. RESULTS: 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). CONCLUSION: 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.
BACKGROUND: 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. OBJECTIVE: The purpose of this study was to determine the impact of revascularization on recurrent VAs or death. METHODS: 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. RESULTS: 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). CONCLUSION: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: Thomas Deneke; Karin Nentwich; Elena Ene; Artur Berkovitz; Kai Sonne; Philipp Halbfaß Journal: Herzschrittmacherther Elektrophysiol Date: 2020-02-06
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Authors: Jean-François Dorval; Louis-Philippe Richer; Luc Soucie; Luke C McSpadden; Adam Hoopai; Stéphanie Tan; Nick E J West; E Marc Jolicoeur Journal: JACC Basic Transl Sci Date: 2021-11-05
Authors: Ahmad Alkharaza; Mousa Al-Harbi; Ihab El-Sokkari; Steve Doucette; Ciorsti MacIntyre; Christopher Gray; Amir Abdelwahab; John L Sapp; Martin Gardner; Ratika Parkash Journal: BMC Cardiovasc Disord Date: 2020-10-21 Impact factor: 2.298