Abstract 12587: Natural History and ICD Implantation Rate Following Revascularization for Stable Coronary Artery Disease With Depressed Ejection Fraction
Objectives: We sought to describe practice patterns related to ICD implantation following revascularization in patients with stable CAD and a depressed LVEF.
Background: Following revascularization by CABG or PCI, CMS requires a 3-month period of maximal medical therapy, followed by reassessment of LVEF, prior to ICD implantation. This post-revascularization waiting period may contribute to incomplete follow-up and may be a source of suboptimal utilization of ICD therapy. The natural history of these patients as well as their fate with regard to eventual ICD implantation is unknown.
Methods: We examined the history of patients with LVEF ≤ 35% but without an ICD who underwent surgical or percutaneous revascularization (CABG or PCI) for stable CAD at our tertiary care hospital between 2008 and 2012. Follow-up used chart review and telephone interviews with patients and/or their relatives.
Results: Among 3164 patients who underwent revascularization (2198 [69%] PCI, 966 [31%] CABG), 3102 (98%) were excluded for one or more reasons: 108 had revascularization for acute coronary syndrome, 2722 had EF >35%, and 64 patients had prior ICD implantation.
The remaining 62 (2%; 33 [53%] M, 67±12y, LVEF 28±6%) had stable CAD, a depressed LVEF, and no ICD.
Over 35±19 months since revascularization, only 14 (23%) of these 62 received an ICD. 35 of the 62 (56%) were no longer candidates for ICD based on improved LVEF, 5 (8%) declined ICD despite physician recommendation, 3 (5%) were not offered ICD despite continued eligibility, 2 (3%) died, 1 (2%) was not a candidate due to ongoing substance abuse, 1 (2%) ICD implantation was temporarily deferred due to need for other medical procedures first, and 1 (2%) was lost to follow up.
Conclusions: Following revascularization for stable CAD with depressed LVEF, more than half (56%) of patients’ LVEFs improved sufficiently to obviate the need for ICD implantation, 23% had ICDs implanted, and 21% did not receive ICDs.
Based on our findings, the current 3-month wait after revascularization prior to ICD implantation appears appropriate. There remains an opportunity to improve care, as 13% did not receive ICDs despite eligibility.
- © 2013 by American Heart Association, Inc.