Adetola Ladejobi1, Deepak K Pasupula1, Shubash Adhikari1, Awais Javed1, Asad F Durrani1, Shantanu Patil1, Dingxin Qin1, Shahzad Ahmad1, Muhammad Bilal Munir1, Shasank Rijal1, Max Wayne1, Evan Adelstein1, Sandeep Jain1, Samir Saba2. 1. From the Department of Internal Medicine and the Heart and Vascular Institute, University of Pittsburgh Medical Center, PA (A.L., D.K.P., S.A., A.J., A.F.D., S.P., D.Q., S.A., M.B.M., E.A., S.J., S.S.); Advocate Heart Institute, Advocate Lutheran General Hospital, Park Ridge, IL (S.R.); and Department of Internal Medicine, University of Michigan, Ann Arbor (M.W.). 2. From the Department of Internal Medicine and the Heart and Vascular Institute, University of Pittsburgh Medical Center, PA (A.L., D.K.P., S.A., A.J., A.F.D., S.P., D.Q., S.A., M.B.M., E.A., S.J., S.S.); Advocate Heart Institute, Advocate Lutheran General Hospital, Park Ridge, IL (S.R.); and Department of Internal Medicine, University of Michigan, Ann Arbor (M.W.). sabas@upmc.edu.
Abstract
BACKGROUND: Current guidelines recommend implantable cardioverter-defibrillator (ICD) therapy in survivors of sudden cardiac arrest (SCA), except in those with completely reversible causes. We sought to examine the impact of ICD therapy on mortality in survivors of SCA associated with reversible causes. METHODS AND RESULTS: We evaluated the records of 1433 patients managed at our institution between 2000 and 2012 who were discharged alive after SCA. A reversible and correctable cause was identified in 792 (55%) patients. Reversible SCA cause was defined as significant electrolyte or metabolic abnormality, evidence of acute myocardial infarction or ischemia, recent initiation of antiarrhythmic drug or illicit drug use, or other reversible circumstances. Of the 792 SCA survivors because of a reversible and correctable cause (age 61±15 years, 40% women), 207 (26%) patients received an ICD after their index SCA. During a mean follow-up of 3.8±3.1 years, 319 (40%) patients died. ICD implantation was highly associated with lower all-cause mortality (P<0.001) even after correcting for unbalanced baseline characteristics (P<0.001). In subgroup analyses, only patients whose SCA was not associated with myocardial infarction extracted benefit from ICD (P<0.001). CONCLUSIONS: In survivors of SCA because of a reversible and correctable cause, ICD therapy is associated with lower all-cause mortality except if the SCA was because of myocardial infarction. These data deserve further investigation in a prospective multicenter randomized controlled trial, as they may have important and immediate clinical implications.
RCT Entities:
BACKGROUND: Current guidelines recommend implantable cardioverter-defibrillator (ICD) therapy in survivors of sudden cardiac arrest (SCA), except in those with completely reversible causes. We sought to examine the impact of ICD therapy on mortality in survivors of SCA associated with reversible causes. METHODS AND RESULTS: We evaluated the records of 1433 patients managed at our institution between 2000 and 2012 who were discharged alive after SCA. A reversible and correctable cause was identified in 792 (55%) patients. Reversible SCA cause was defined as significant electrolyte or metabolic abnormality, evidence of acute myocardial infarction or ischemia, recent initiation of antiarrhythmic drug or illicit drug use, or other reversible circumstances. Of the 792 SCA survivors because of a reversible and correctable cause (age 61±15 years, 40% women), 207 (26%) patients received an ICD after their index SCA. During a mean follow-up of 3.8±3.1 years, 319 (40%) patients died. ICD implantation was highly associated with lower all-cause mortality (P<0.001) even after correcting for unbalanced baseline characteristics (P<0.001). In subgroup analyses, only patients whose SCA was not associated with myocardial infarction extracted benefit from ICD (P<0.001). CONCLUSIONS: In survivors of SCA because of a reversible and correctable cause, ICD therapy is associated with lower all-cause mortality except if the SCA was because of myocardial infarction. These data deserve further investigation in a prospective multicenter randomized controlled trial, as they may have important and immediate clinical implications.