HOME SUBSCRIPTIONS CURRENT ISSUE PAST ISSUES CARDIOSOURCE SEARCH HELP FEEDBACK		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Figures Only Full Text Full Text (PDF) All Versions of this Article: j.jacc.2005.12.048v1 47/9/1811    most recent Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Related articles in JACC Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via ISI Web of Science (9) Citing Articles via Google Scholar Google Scholar Articles by Goldenberg, I. Search for Related Content PubMed PubMed Citation Articles by Goldenberg, I.

CLINICAL RESEARCH: HEART RHYTHM DISORDERS

Time Dependence of Defibrillator Benefit After Coronary Revascularization in the Multicenter Automatic Defibrillator Implantation Trial (MADIT)-II

Ilan Goldenberg, MD^_*,_*, Arthur J. Moss, MD^_*, Scott McNitt, MS^_*, Wojciech Zareba, MD, PhD^_*, W. Jackson Hall, PhD, Mark L. Andrews, BBS^_*, David J. Wilber, MD, Helmut U. Klein, MD for the MADIT-II Investigators

^_* Cardiology Unit, Department of Medicine, University of Rochester Medical Center, Rochester, New York
Department of Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester, New York
Cardiovascular Institute, Loyola University Medical Center, Maywood, Illinois
Division of Cardiology, University Hospital, Magdeburg, Germany

Manuscript received September 6, 2005; revised manuscript received December 5, 2005, accepted December 13, 2005.

^_* Reprint requests and correspondence: Dr. Ilan Goldenberg, Heart Research Follow-Up Program, Box 653, University of Rochester Medical Center, Rochester, New York 14642 (Email: ilan.goldenberg{at}heart.rochester.edu).

OBJECTIVES: The study was designed to assess the effect of elapsed time from coronary revascularization (CR) on the benefit of the implantable cardioverter-defibrillator (ICD) and the risk of sudden cardiac death (SCD) in patients with ischemic left ventricular dysfunction.

BACKGROUND: The ICD improves survival in appropriately selected high-risk cardiac patients by 30% to 54%. However, in the Coronary Artery Bypass Graft (CABG)-Patch trial no evidence of improved survival was shown among a similar population of patients in whom an ICD was implanted prophylactically at the time of elective CABG.

METHODS: The outcome by time from CR was analyzed in 951 patients in whom a revascularization procedure was performed before enrollment in the Multicenter Automatic Defibrillator Implantation Trial (MADIT)-II.

RESULTS: The adjusted hazard ratio (HR) of ICD versus conventional therapy was 0.64 (p = 0.01) among patients enrolled more than six months after CR, whereas no survival benefit with ICD therapy was shown among patients enrolled six months or earlier after CR (HR = 1.19; p = 0.76). In the conventional therapy group, the risk of cardiac death increased significantly with increasing time from CR (p for trend = 0.009), corresponding mainly to a six-fold increase in the risk of SCD among patients enrolled more than six months after CR.

CONCLUSIONS: In patients with ischemic left ventricular dysfunction, the efficacy of ICD therapy after CR is time dependent, with a significant life-saving benefit in patients receiving device implantation more than six months after CR. The lack of ICD benefit when implanted early after CR may be related to a relatively low risk of SCD during this time period.

Abbreviations and Acronyms   CABG = coronary artery bypass graft   CHD = coronary heart disease   CR = coronary revascularization   ICD = implantable cardioverter-defibrillator   MADIT = Multicenter Automatic Defibrillator Implantation Trial   PCI = percutaneous coronary intervention   SCD = sudden cardiac death

Related articles in JACC:

Tincture of Time: When to Implant a Prophylactic Cardioverter-Defibrillator Following Coronary Revascularization?

Anne M. Gillis
JACC 2006 47: 1818-1819. [Full Text]  

This article has been cited by other articles:

				I. Goldenberg and A. J. Moss Long QT syndrome. J. Am. Coll. Cardiol., June 17, 2008; 51(24): 2291 - 2300. [Abstract] [Full Text] [PDF]

				C. A. Herzog, J. W. Strief, A. J. Collins, and D. T. Gilbertson Cause-specific mortality of dialysis patients after coronary revascularization: why don't dialysis patients have better survival after coronary intervention? Nephrol. Dial. Transplant., February 25, 2008; (2008) gfn038v1. [Abstract] [Full Text] [PDF]

				J. A. Ezekowitz, B. H. Rowe, D. M. Dryden, N. Hooton, B. Vandermeer, C. Spooner, and F. A. McAlister Systematic Review: Implantable Cardioverter Defibrillators for Adults with Left Ventricular Systolic Dysfunction Ann Intern Med, August 21, 2007; 147(4): 251 - 262. [Abstract] [Full Text] [PDF]

				T. J. Bunch, S. H. Hohnloser, and B. J. Gersh Mechanisms of Sudden Cardiac Death in Myocardial Infarction Survivors: Insights From the Randomized Trials of Implantable Cardioverter-Defibrillators Circulation, May 8, 2007; 115(18): 2451 - 2457. [Full Text] [PDF]

				A. N. DeMaria, O. Ben-Yehuda, G. K. Feld, G. S. Ginsburg, B. H. Greenberg, W. Y.W. Lew, J. A.C. Lima, A. S. Maisel, J. Narula, D. J. Sahn, et al. Highlights of the Year in JACC 2006 J. Am. Coll. Cardiol., January 30, 2007; 49(4): 509 - 527. [Full Text] [PDF]

				I. Goldenberg and A. J. Moss Reply J. Am. Coll. Cardiol., January 2, 2007; 49(1): 125 - 125. [Full Text] [PDF]

				P. Pascale and M. Fromer Time Dependence of Defibrillator Benefit Postcoronary Revascularization J. Am. Coll. Cardiol., January 2, 2007; 49(1): 124 - 125. [Full Text] [PDF]

				A. M. Gillis Tincture of Time: When to Implant a Prophylactic Cardioverter-Defibrillator Following Coronary Revascularization? J. Am. Coll. Cardiol., May 2, 2006; 47(9): 1818 - 1819. [Full Text] [PDF]