JACC
HOME SUBSCRIPTIONS CURRENT ISSUE PAST ISSUES CARDIOSOURCE SEARCH HELP FEEDBACK
QUICK SEARCH:   [advanced]


     

J Am Coll Cardiol, 2006; 47:1811-1817, doi:10.1016/j.jacc.2005.12.048 (Published online 11 April 2006).
© 2006 by the American College of Cardiology Foundation
This Article
Right arrow Abstract Freely available
Right arrow Figures Only
Right arrow Full Text (PDF)
Right arrow All Versions of this Article:
j.jacc.2005.12.048v1
47/9/1811    most recent
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Related articles in JACC
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via ISI Web of Science (9)
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Goldenberg, I.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow 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{dagger}, Mark L. Andrews, BBS*, David J. Wilber, MD{ddagger}, Helmut U. Klein, MD§ for the MADIT-II Investigators

* Cardiology Unit, Department of Medicine, University of Rochester Medical Center, Rochester, New York
{dagger} Department of Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester, New York
{ddagger} 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).


   Abstract
Top
 Abstract
Methods
 Results
 Discussion
 References
 
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

Sudden cardiac death (SCD) constitutes about one-quarter of all coronary heart disease (CHD)-related major events and more than half of all CHD-related deaths. Ventricular arrhythmia is believed to be the most common direct cause (1). Coronary heart disease patients with left ventricular dysfunction have been shown to be at high risk for SCD, and in this population the implantable cardioverter-defibrillator (ICD) has been demonstrated to reduce mortality by 30% to 54% (2–6) and the risk of SCD by 67% (7). The Coronary Artery Bypass Graft (CABG)-Patch trial, however, failed to show a benefit from ICD therapy in a similar population of high-risk cardiac patients who were undergoing CABG surgery (8). The lack of ICD benefit in this study may be related to the proximity of device implantation to the coronary revascularization (CR) procedure, compared with other primary prevention ICD trials (2–5).

The present study was performed to evaluate the effect of elapsed time from CR on ICD benefit and the risk of SCD in high-risk CHD patients enrolled in the Multicenter Automatic Defibrillator Implantation Trial (MADIT)-II.


   Methods
Top
 Abstract
 Methods
Results
 Discussion
 References
 
The design and results of the MADIT-II study have been reported elsewhere (3). Briefly, 1,232 patients with documented prior myocardial infarction and a left ventricular ejection fraction of ≤30% were randomized to receive a prophylactic ICD or conventional medical therapy in a 3:2 ratio. Screened patients were excluded from enrollment if they had class IV congestive heart failure, CR within the previous three months, elapsed interval from most recent myocardial infarction of <1 month, or advanced medical comorbidity. After a mean follow-up of 20 months, the study was terminated by the Data Safety and Monitoring Board. Unadjusted mortality was 19.8% in the conventional therapy group and 14.2% in the ICD group, and the overall hazard ratio (HR) was 0.69 (95% confidence interval [CI] 0.51 to 0.93).

Nine hundred fifty-one patients who had CABG and/or percutaneous coronary intervention (PCI) before enrollment were included in the current analysis (time from last CR: mean 64.44 ± 58.22 months, median 48.89 months, interquartile range 82.50 months); 580 of the patients who had undergone CR were allocated to the ICD group, and 371 were allocated to the conventional therapy group. In 12 patients CR was performed three months or less before enrollment owing to authorized protocol deviations. Time-dependence of mortality and ICD benefit was examined by dividing times from most recent CR procedure to enrollment into an early post-CR period (6 months or less); an intermediate post-CR period (6 to 60 months); and a late post CR period (more than 60 months). Those time frames were chosen based upon current knowledge of the natural history of coronary artery disease progression after CR (9,10). Accordingly, during the early period there is little progression in graft disease (9), and the process of restenosis after coronary stenting is usually complete, with little progression thereafter (10); during the intermediate period new stenoses develop in graft conduits and/or native vessels, but most (80%) of the post-CABG patients are free from angina (9); and during the late period there is accelerated graft stenosis and/or degeneration and progression of native coronary artery disease (9).

A modified Hinkle-Thaler system was used to classify deaths, as described previously (7).

Statistical analysis.   Baseline characteristics of the patients within the post-CR subgroups were compared and contrasted using the chi-square test and Fisher exact test, as appropriate. Significant variables affecting outcome were incorporated into a Cox proportional-hazards regression model to determine covariate-adjusted hazard ratios for: 1) ICD benefit by time from CR; and 2) the mode of death by time from CR in conventionally treated patients. Kaplan-Meier estimates of all-cause mortality by treatment group, stratified according to time from CR, were estimated and graphically displayed according to the method of Kaplan and Meier, with comparison of cumulative events by the log-rank test. Analyses were performed with the use of SAS software (version 9.13, SAS Institute, Cary, North Carolina), and a two-sided probability value of <0.05 was used for declaring statistical significance.


   Results
Top
 Abstract
 Methods
 Results
Discussion
 References
 
Of the 951 patients who underwent CR, 130 patients had the procedure ≤6 months before enrollment in the study (early: mean ± SD 4 ± 1 months, median 4 months, interquartile range 3 to 5 months), 414 patients within 6 to 60 months (intermediate: mean ± SD 30 ± 16 months, median 27 months, interquartile range 15 to 44 months), and 404 patients >60 months (late: mean ± SD 119 ± 48 months, median 107 months, interquartile range 81 to 147 months). Seventy-four percent of the patients who underwent CR had CABG at any time in their past, 57% had PCI, and both procedures were performed in 31% of patients. Baseline characteristics of study patients in the post-CR subgroups are shown in Table 1. Compared with the early and intermediate post-CR subgroups, the late post-CR subgroup had a higher proportion of older patients (≥65 years), a lower frequency of female patients, and a higher proportion of patients who had CABG as their last CR procedure before enrollment. The proportion of patients with diabetes mellitus, a low ejection fraction (<25%), and electrocardiographic abnormalities, including left bundle branch block and a QRS duration of >0.12 s, increased with increasing time after CR, whereas medical therapy with beta-blockers was administered less frequently with increasing time after CR. There were no significant differences between the conventional and ICD treatment groups with regard to baseline clinical characteristics within the post-CR subgroups (data not shown).


View this table:
[in this window]
[in a new window]
  		Table 1. Baseline Characteristics by Time From CR
 
Defibrillator efficacy by elapsed time from coronary revascularization.   Among patients enrolled during the early post-CR period, the two-year Kaplan-Meier estimates of all-cause mortality in the ICD and conventional therapy groups were similar (Fig. 1A); whereas among patients enrolled after the early post-CR period, all-cause mortality rates were lower in the ICD group than in the conventional therapy group (Figs. 1B and 1C).


Figure 1
View larger version (14K):
[in this window]
[in a new window]
  		Figure 1 Kaplan-Meier estimates of probability of all-cause mortality by treatment group among patients enrolled (A) ≤6 months after coronary revascularization (CR), (B) 7 to 60 months after coronary revascularization, and (C) >60 months after coronary revascularization. ICD = implantable cardioverter-defibrillator.

 
In multivariate analysis (Table 2), ICD therapy was associated with an overall 30% reduction in the risk of all-cause mortality (p = 0.01). There was a significant 36% reduction in the risk of all-cause mortality among patients who had CR >6 months before enrollment, corresponding to a significant 45% and a marginally significant 33% reduction in the risk of all-cause mortality among patients enrolled during the intermediate and late post-CR periods, respectively. No survival benefit with ICD therapy was shown among patients in whom the device was implanted during the early post-CR period. The benefit of ICD therapy after the early post-CR period was consistent when narrower post-CR time intervals were analyzed (Fig. 2).


View this table:
[in this window]
[in a new window]
  		Table 2. Multivariate Analysis: ICD Efficacy by Elapsed Time From CR
 

Figure 2
View larger version (21K):
[in this window]
[in a new window]
  		Figure 2 Two-year Kaplan-Meier estimates of all-cause mortality in the two treatment groups by time from coronary revascularization. Solid bars = conventional (conv); open bars = implantable cardioverter-defibrillator (ICD).

 
Defibrillator therapy was associated with an overall significant 63% reduction in the risk of SCD (p < 0.001). When analyzed by elapsed time from CR, treatment with an ICD was associated with a significant reduction in the risk of SCD in each CR period >6 months before enrollment (7 to 60 months: 73% reduction; p = 0.004; >60 months: 60% reduction; p = 0.03; corresponding to a 66% reduction in the risk of SCD among patients enrolled during the overall >6 months post-CR period; p < 0.001). Defibrillator therapy did not reduce SCD risk in patients enrolled during the early post-CR period, and a trend to an interaction between the ≤6 months and >6 months post-CR periods was observed when the efficacy of ICD for reducing SCD risk was analyzed (p value for treatment-time interaction = 0.16). Kaplan-Meier estimates of the cumulative probability of SCD 1 and 2 years after enrollment demonstrated very low, and similar, SCD rates in the ICD and conventional therapy groups among patients in whom CR was performed ≤6 months before enrollment (Fig. 3A). The rate of SCD was increased in patients in whom CR was performed after this time period in the two treatment groups; and one- and two-year rates of SCD were significantly lower in the ICD group than in the conventional therapy group in patients who enrolled in the intermediate (Fig. 3B) and late (Fig. 3C) post-CR periods.


Figure 3
View larger version (14K):
[in this window]
[in a new window]
  		Figure 3 Kaplan-Meier estimates of probability of sudden cardiac death by treatment group among patients enrolled (A) ≤6 months after coronary revascularization (CR), (B) 7 to 60 months after coronary revascularization, and (C) >60 months after coronary revascularization. ICD = implantable cardioverter-defibrillator.

 
Although subgroup analysis of CABG surgery or PCI was associated with too few events to carry out a separate Cox analysis, Kaplan-Meier estimates of the cumulative rate of all-cause mortality and SCD at two years among patients who had CABG as an isolated procedure, PCI as an isolated procedure, or multiple revascularization procedures before enrollment demonstrated consistent results. Each therapeutic modality was associated with similar survival rates in the ICD and conventional therapy groups among patients in whom the procedure was performed ≤6 months before enrollment and with improved survival in ICD-allocated patients in whom the procedure was performed >6 months before enrollment (Table 3).


View this table:
[in this window]
[in a new window]
  		Table 3. Two-Year Kaplan-Meier Cumulative Probabilities of All-Cause Mortality and Sudden Cardiac Death in Each Subgroup of CR Type by Time From CR
 
Analysis of mortality events in the conventional group.   Mortality rates in conventionally treated patients increased as a function of time from the most recent CR to enrollment (unadjusted all-cause mortality rates: 10%, 15%, and 25% in the respective early, intermediate, and late post-CR subgroups; p = 0.01). Cox regression analysis (Table 4) showed a significant increase in the risk of all-cause mortality and cardiac death with increasing time from CR (p for trend = 0.01 and 0.009, respectively). The increase in risk of cardiac death >6 months after CR was related mainly to a six-fold increase in the risk of SCD among patients enrolled during this time period as compared with patients enrolled ≤6 months after CR (p for trend = 0.07), whereas the risk of non-SCD was not significantly different among the three post-CR subgroups (p for trend = 0.56). Although the number of deaths was small, the proportion of sudden cardiac deaths to total deaths was 17% among patients enrolled during the early post-CR period and 60% among patients enrolled after this time period (p = 0.04) (Fig 4).


View this table:
[in this window]
[in a new window]
  		Table 4. Adjusted Mortality Risk by Elapsed Time from Revascularization in the Conventional Group
 

Figure 4
View larger version (17K):
[in this window]
[in a new window]
  		Figure 4 The ratio of sudden cardiac death to all-cause mortality by elapsed time from coronary revascularization in the conventional therapy group; p = 0.18 for the comparison of the four time periods; p = 0.04 for the comparison of ≤6 months to >6 months. SCD = sudden cardiac death.

 

   Discussion
Top
 Abstract
 Methods
 Results
 Discussion
References
 
We have shown that in patients with ischemic left ventricular dysfunction, the benefit of ICD therapy after CR is time dependent. There was a significant 36% and 68% reduction in the risk of all-cause mortality and SCD, respectively, in patients who had undergone CR more than six months before enrollment, whereas no such benefit was demonstrated in patients enrolled within six months after CR. The change in ICD efficacy corresponded to a significant increase in the risk of cardiac death more than six months after CR in conventionally treated patients, attributed mainly to a six-fold increase in the risk of SCD, whereas no change in the risk of non-SCD was observed with increasing time after CR. Thus, the lack of ICD benefit when implanted early after CR may be related to the relatively low risk of arrhythmic mortality during this time period.

Myocardial ischemia has been suggested to be an important trigger for development of ventricular tachyarrhythmias (11). Therefore, CR may attenuate subsequent SCD risk. The Coronary Artery Surgery Study (12) and European Coronary Surgery Study (13) demonstrated reductions in SCD with surgical revascularization versus medical therapy in a population of patients with normal, or mildly reduced, left ventricular function. A subsequent analysis of the Studies of Left Ventricular Dysfunction trials (14) showed that in patients with an ejection fraction of ≤35%, prior CABG was independently associated with a significant 25% reduction in risk of death and a 46% reduction in risk of SCD. This study, however, did not analyze the effect of elapsed time from CR on mortality risk. We have shown, in a similar population of patients with left ventricular dysfunction, that risk reduction conferred by CR was confined mainly to the early (six months or less) post-CR period.

Our findings are consistent with those of the CABG-Patch trial, in which no evidence of improved survival was shown among patients with CHD, a depressed left ventricular ejection fraction, and an abnormal signal-averaged electrocardiogram in whom an ICD was implanted prophylactically at the time of CABG (8). Notably, the hazard ratio for ICD benefit in the CABG-Patch trial (1.07; p = 0.64) was very similar to that demonstrated among patients in whom the ICD was implanted during the early post-CR period in the MADIT-II study (1.19; p = 0.76). Further analysis of the CABG-Patch trial, revealed that most of the deaths (71%) in the study were nonarrhythmic in nature (15). In the current study, we have similarly shown that the mode of death among patients enrolled during the early post-CR period was dominated by nonarrhythmic mortality (83%), whereas after this early time period the proportion of deaths that were nonsudden in nature was reduced to 40%. Thus, it appears that both in MADIT-II study and the CABG-Patch trial, the lack of defibrillator benefit when implanted in proximity to a CR procedure, was related to the fact that most of deaths during this time period were nonarrhythmic in nature.

A previous analysis of the MADIT-II study (16) has demonstrated that a significant decrease in the risk of SCD with ICD therapy was apparent within one year after enrollment, whereas during this time period the rate of non-SCD was significantly higher in the ICD group than in the conventional therapy group, leading to an overall significant survival benefit with ICD therapy only after the first year of the trial. In the present study we have consistently shown that among patients enrolled more than six months after CR the rates of SCD were significantly lower in the ICD group than in the conventional therapy group within both one and two years after enrollment, leading to an overall survival benefit with ICD therapy at two years in patients who enrolled in the intermediate and late post-CR periods. In contrast, SCD rates in patients enrolled in the early post-CR period were similar in the two treatment arms throughout the study, leading to a neutral effect of ICD therapy on all-cause mortality at two years in this subgroup of patients.

Study limitations.   Coronary revascularization was not a randomized event in the MADIT-II study; therefore, there were significant differences in the baseline characteristics among the post-CR subgroups. However, adjusting for those differences did not explain the differences in outcome among the post-CR subgroups.

Patients were excluded from enrollment in the MADIT-II study if their most recent CR procedure was performed within three months before enrollment (only 12 patients were included within this time period owing to authorized protocol deviations). Therefore, the current results do not include sufficient data on the immediate post-CR period in which an even lower risk of SCD may exist, corresponding to a further reduction in ICD benefit during this time period.

As compared with PCI, CABG provides a more complete revascularization of the coronary arteries. Therefore, the latter revascularization modality may afford better protection against arrhythmic mortality than the former. Data on the completeness of revascularization were not available in the current study. Thus, the effect of this important factor was not analyzed. The consistent trends among patients who underwent PCI as an isolated procedure suggest that recent revascularization, limited to the target vessel, may also reduce the risk of arrhythmic mortality.

Conclusions.   We have shown that ICD therapy is associated with a significant survival benefit and reduction in SCD risk after CR. This life-saving benefit, however, is time dependent, and in the current analysis of the MADIT-II study, improved survival was apparent when the ICD was implanted more than six months after CR. Our findings suggest that the early post-CR period is dominated by nonarrhythmic mortality and may explain the lack of defibrillator benefit in the CABG-Patch trial. Further prospective studies are needed to delineate the optimal timing of device implantation after CR. At present, the relatively low risk of arrhythmic mortality during the early period after successful CR should be considered when planning ICD implantation for the primary prevention of SCD in CHD patients with advanced left ventricular dysfunction.


   Footnotes
 
The MADIT-II study was supported by a research grant from Guidant Corporation, St. Paul, Minnesota, to the University of Rochester School of Medicine and Dentistry. Drs. Moss, Zareba, Hall, Wilber, and Klein are Guidant grant recipients.


   References
Top
 Abstract
 Methods
 Results
 Discussion
 References
 

  1. Myerburg RJ, Kessler KM, Castellanos A. Sudden cardiac deathepidemiology, transient risk, and intervention assessment. Ann Intern Med 1993;119:1187-1197.[Abstract/Free Full Text]
  2. Bardy GH, Lee KL, Mark DB, et al. Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT) Investigators Amiodarone or an implantable cardioverter-defibrillator for congestive heart failure N Engl J Med 2005;352:225-237.[Abstract/Free Full Text]
  3. Moss AJ, Zareba W, Hall WJ, et al. Multicenter Automatic Defibrillator Implantation Trial II Investigators Prophylactic implantation of a defibrillator in patients with myocardial infarction and reduced ejection fraction N Engl J Med 2002;346:877-883.[Abstract/Free Full Text]
  4. Buxton AE, Lee KL, Fisher JD, Josephson ME, Prystowsky EN, Hafley G, Multicenter Unsustained Tachycardia Trial Investigators A randomized study of the prevention of sudden death in patients with coronary artery disease N Engl J Med 1999;341:1882-1890.[Abstract/Free Full Text]
  5. Moss AJ, Hall WJ, Cannom DS, et al. Multicenter Automatic Defibrillator Implantation Trial Investigators Improved survival with an implanted defibrillator in patients with coronary disease at high risk for ventricular arrhythmia N Engl J Med 1996;335:1933-1940.[Abstract/Free Full Text]
  6. Antiarrhythmics Versus Implantable Defibrillators (AVID) Investigators A comparison of antiarrhythmic-drug therapy with implantable defibrillators in patients resuscitated from near-fatal ventricular arrhythmias N Engl J Med 1997;337:1576-1583.[Abstract/Free Full Text]
  7. Greenberg H, Case RB, Moss AJ, Brown MW, Carroll ER, Andrews ML, MADIT-II Investigators Analysis of mortality events in the Multicenter Automatic Defibrillator Implantation Trial (MADIT-II) J Am Coll Cardiol 2004;43:1459-1465.[Abstract/Free Full Text]
  8. Bigger Jr. JT, Coronary Artery Bypass Graft (CABG) Patch Trial Investigators Prophylactic use of implanted cardiac defibrillators in patients at high risk for ventricular arrhythmias after coronary-artery bypass graft surgery N Engl J Med 1997;337:1569-1575.[Abstract/Free Full Text]
  9. Eagle KA, Guyton RA, Davidoff R, et al. American College of Cardiology; American Heart Association ACC/AHA 2004 guideline update for coronary artery bypass graft surgery Circulation 2004;110:1168-1176.[Free Full Text]
  10. Smith Jr. SC, Dove JT, Jacobs AK, et al. American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Revise the 1993 Guidelines for Percutaneous Transluminal Coronary Angioplasty), Society for Cardiac Angiography and Interventions ACC/AHA guidelines for percutaneous coronary intervention Circulation 2001;103:3019-3041.[Free Full Text]
  11. O’Rourke RA. Role of myocardial revascularization in sudden cardiac death Circulation 1992;85:I112-I117.[Medline]
  12. Holmes Jr. DR, Davis KB, Mock MB, et al. The effect of medical and surgical treatment on subsequent sudden cardiac death in patients with coronary artery diseasea report from the Coronary Artery Surgery Study. Circulation 1986;73:1254-1263.[Abstract/Free Full Text]
  13. European Coronary Surgery Study Group Long-term results of prospective randomised study of coronary artery bypass surgery in stable angina pectoris Lancet 1982;2:1173-1180.[Medline]
  14. Veenhuyzen GD, Singh SN, McAreavey D, Shelton BJ, Exner DV. Prior coronary artery bypass surgery and risk of death among patients with ischemic left ventricular dysfunction Circulation 2001;104:1489-1493.[Abstract/Free Full Text]
  15. Bigger Jr. JT, Whang W, Rottman JN, et al. Mechanisms of death in the CABG Patch triala randomized trial of implantable cardiac defibrillator prophylaxis in patients at high risk of death after coronary artery bypass graft surgery. Circulation 1999;99:1416-1421.[Abstract/Free Full Text]
  16. Moss AJ, Vyas A, Greenberg H, et al. MADIT-II Research Group Temporal aspects of improved survival with the implanted defibrillator (MADIT-II) Am J Cardiol 2004;94:312-315.[CrossRef][Medline]

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:


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

Home page
 Nephrol Dial TransplantHome page
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]

Home page
 ANN INTERN MEDHome page
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]

Home page
 CirculationHome page
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]

Home page
 J Am Coll CardiolHome page
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]

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

Home page
 J Am Coll CardiolHome page
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]

Home page
 J Am Coll CardiolHome page
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]

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

HOME SUBSCRIPTIONS CURRENT ISSUE PAST ISSUES CARDIOSOURCE SEARCH HELP FEEDBACK