This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Weintraub, W. S. Search for Related Content PubMed PubMed Citation Articles by Weintraub, W. S.

(Circulation. 2001;104:1457.)
© 2001 American Heart Association, Inc.

Editorials

Revascularization Versus Implantable Cardioverter-Defibrillators to Prevent Sudden Death in Patients With Severe Left Ventricular Dysfunction

William S. Weintraub, MD

From the Emory Center for Outcomes Research, Atlanta, Ga.

Correspondence to William S. Weintraub, MD, Professor of Medicine, Emory Center for Outcomes Research, 1256 Briarcliff Rd, Suite 1N, Atlanta, GA 30306. E-mail wweintr@emory.edu

Key Words: Editorials • revascularization • death, sudden • cardioversion • defibrillation

Sudden death remains a dreaded consequence of coronary artery disease, and efforts to predict its incidence and to prevent its occurrence remain a major concern. A number of the challenges in management are highlighted in the article by Veenhuyzen et al¹ in the present issue of Circulation. In their study, mortality and modes of death were assessed in 5410 patients with ischemic left ventricular function who were enrolled in the Studies of Left Ventricular Dysfunction (SOLVD) study.² There were 1870 patients who had had prior coronary artery bypass grafting (CABG) and 3540 who had not had prior CABG. The SOLVD trial database is a good source for these data, both because it is large and because the cause of death (ie, whether cardiac and whether sudden or not) was established.

See p 1489

The key findings of Veenhuyzen et al¹ are that CABG was associated with a 25% reduction in the risk of death (from 24.3% to 18.4%) and a 46% reduction in the risk of sudden death (from 7.5% to 4.1%). These findings are independent of ejection fraction, severity of heart failure symptoms, age, and other clinical variables. In a stratified analysis by severity of left ventricular dysfunction, there was some evidence for interaction, but similar results were noted overall. Prior CABG was not associated with an alteration in the risk of death from progressive heart failure. The results were applied to a group of patients with left ventricular dysfunction from the Coronary Artery Surgery Study Registry who . . . [Full Text of this Article]