Abstract 9816: Use of the Wearable Cardioverter Defibrillator and Survival After Coronary Artery Revascularization in Patients with Left Ventricular Dysfunction
Background: ICD implantation for primary prevention of sudden cardiac death (SCD) is typically deferred in the immediate post revascularization period due to reimbursement restrictions, but mortality risk may be highest early after cardiac procedures. The wearable cardioverter-defibrillator (WCD) is a noninvasive device capable of protection from SCD and may be useful during this period.
Objective: To determine if there is a difference in survival of patients with LVEF≤35% from a national registry using a WCD after revascularization compared to patients with LVEF≤35% discharged after surgical or percutaneous revascularization without the WCD.
Methods: Kaplan-Meier survival, Cox proportional hazards and propensity score matched analyses were performed to determine if survival differed in patients discharged after surgical (CABG) or percutaneous (PCI) coronary revascularization with LVEF≤35% from a national database of WCD users (N=809) compared to patients with LVEF≤35% from surgical and interventional registries at the Cleveland Clinic (N=4149).
Results: Survival curves showed higher early compared to late mortality in the non-WCD groups with 90-day mortality after CABG of 3% in WCD users vs. 7% in non-users and after PCI 2% in WCD users vs. 10% in the non WCD users. WCD use was associated with an adjusted 57% lower risk of death (p<0.0001) among post-PCI patients over a mean follow up of 3.1±2.3 years and an adjusted 38% lower risk of death in post CABG patients (p value 0.048) over a mean follow up of mean follow-up 3.2 ± 2.5 years. Limitations: Adjustment for co-morbidities was limited in this single center vs. national database study.
Conclusions: In patients with LVEF <35%, WCD users did not demonstrate the high early phase mortality after revascularization that was seen in the non-WCD users. These findings provide a rationale for additional studies of WCD use after revascularization in patients with LV dysfunction.
- © 2011 by American Heart Association, Inc.