927-37 Is Coronary Revascularization Complete Therapy for Secondary Prevention of Ischemic Cardiac Arrest?

Abstract

Coronary revascularization has been suggested assole therapy for secondary prevention of sudden cardiac arrest associated with ischemia. Among 412 consecutive patients receiving an implantable defibrillator (ICD), 23 (6%) were identified as: sudden cardiac arrest survivors, noninducible with programmed stimulation, unstable angina or ischemia on a functional study, and underwent successful coronary revascularization. In follow-up, 10 (43%) of the 23 patients received ICD shocks (8 ± 8 per patient, range: 1–22) shocks) and 9/10 had syncope/presyncope associated with at least one ICD discharge. Clinical Characteristics: ICD firings (n = 10) * No ICD firings (n = 13) * Follow-up (months) 39 ± 13 31 ± 21 Age (years) 63 ± 7 63 ± 12 Male gender 8 9 Mean left ventricular ejection fraction (%) 36 ± 10 40 ± 14 Previous history of a myocardial infarction 10 10 Presence of a left ventricular aneurysm 4 1 Q-wave infarction pattern on electrocardiogram 7 5 Sudden cardiac arrest presenting with exertion, angina, or CPK elevation 8 8 Mean number of vessels with coronary disease 2.2 ± 0.8 23 ± 0.9 Mean severity of coronary stenosis (%) 87 ± 18 88 ± 16 Coronary revascularization considered complete 7 10 β -blocker therapy 5 5 Antiarrhythmic therapy 8 12 * p value > 0.05 No clinical characteristic was statistically different between patients with and without ICD shocks. In conclusion, coronary revascularization alone may be inadequate therapy for survivors of sudden cardiac arrest associated with ischemia who are noninducible with programmed stimulation, and clinical variables cannot predict which patients are likely to experience recurrent malignant ventricular arrhythmias. Therefore, ICD therapy should be considered in these patients.