219-04: Survival of patients with Ischemic Cardiomyopathy and Severe Systolic Dysfunction not undergoing Implantable Cardioverter Defibrillator

Abstract

Introduction: Coronary artery disease (CAD) is the primary cause in two thirds of heart failure (HF) cases with uncontrolled ischemic disease. Tachyarrhythmia is common in this scenario, providing significant mortality increase in patients with ischemic cardiomyopathy (ICM) and HF. Current guidelines highlight recent advances in pharmacologic, surgical, and device therapies that have improved the quality of life and survival of this population. One could ask whether current therapeutic approach could change the results of classic clinical trials using implantable cardioverter defibrillator (ICD) for primary prevention of sudden cardiac death (SCD). The optimal treatment approach offered to the population of these studies is clearly different from the current one. Objectives: The aims of this study are to determine the mortality rates of patients with ICM and severe ventricular dysfunction not undergoing ICD implantation, in a tertiary hospital; compare our findings with those of classical studies and to identify prognostic predictors. Methods: This is an observational and prospective study, including patients with CAD and left ventricular ejection fraction (LVEF) ≤35% which included 479 patients between August 2010 and January 2014. Overall mortality was estimated by the Kaplan-Meier method, univariate comparisons were made with log rank test. Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated from individual variable and multiple Coxregression analyses. Results: It was registered 76.6% of men in the cohort and the mean age was 65.3 ± 10.4ys. Atrial fibrillation was present in 10.7% and the mean LVEF was 0.29 ± 0.05. Hypertension, diabetes and kidney disease (CKD) were presented in 85.6%, 52.4% and 51.1% respectively. Medications such as β-blockers, ACEI/ARBs, statins and antiplatelet agents were used more by 85%. During a mean follow-up of 1.74ys the numbers of deaths were 68 and 4 heart transplant (counted here as death) of which 66% cardiac. The annual mortality rate was 8.8% and arrhythmic mortality of 1.44%. These death rates are similar to those found in prophylactic studies with CDI, as MADIT I and SCD-HeFT (1.40 and 1.17 respectively). But the studied populations (from this study and from the classical ICD studies) were differently medicated. The presence of AF, diabetes mellitus, CKD and male sex were independent predictors of mortality. Conclusion: The findings of this study showed all-cause and arrhythmic mortality rate similar to the findings of primary prevention studies under ICD arm. These findings may be attributable to the advancement of therapeutic approach and suggests reassessing the ICD use for SCD primary prevention.