Abstract
INTRODUCTION: Left ventricular ejection fraction (EF) ≤ 35% is the cornerstone criterion for implantable cardioverter-defibrillator (ICD) eligibility. Improvement in EF may occur in ICD-eligible patients after coronary artery bypass graft surgery (CABG). However, the incidence, predictors, and outcomes of this process are unclear.
METHODS AND RESULTS: We studied 427 patients with EF ≤ 35% who underwent CABG in the Surgical Treatment for Ischemic Heart Failure (STICH) trial and had a systematic pre- and postoperative (4 months) EF assessment using the identical cardiac imaging modality. All imaging studies were interpreted at a core laboratory. Improvement in EF was defined as postoperative EF > 35% and >5% absolute improvement from baseline. Of the 427 patients (mean age 61.8 ± 9.5 and 50 women), 125 (29.2%) had EF improvement. Their mean EF increased from 26.8% (±5.8%) to 43.3% (±6.5%) (p < .0001). EF improvement occurred in only 20% of patients with a preoperative EF < 25%. The odds of EF improvement were 1.96 times higher (95% confidence interval [CI]: 0.91-4.23, p = .09) in patients with myocardial viability. In adjusted analyses, EF improvement was associated with a significantly lower risk of all-cause mortality (hazard ratio [HR]: 0.58, 95% CI: 0.35-0.96; p = .03) and heart failure mortality (HR: 0.31, 95% CI: 0.11-0.87; p = .027).
CONCLUSION: Nearly 1/3rd of ICD-eligible patients undergoing CABG had significant improvement in EF, obviating the need for primary prevention ICD implantation. These results provide patients and clinicians data on the likelihood of ICD eligibility after CABG and support the practice of reassessment of EF after revascularization.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 244-251 |
| Number of pages | 8 |
| Journal | Journal of cardiovascular electrophysiology |
| Volume | 33 |
| Issue number | 2 |
| DOIs | |
| State | Published - Feb 2022 |
Bibliographical note
Funding Information:: Dr. Adabag received grant support from Medtronic. Other authors: No disclosures. Disclosure
Funding Information:
The authors are grateful to the patients and investigators who performed the STICH trial. The authors are also grateful to the National Heart Lung and Blood Institute Biologic Specimen and Data Repository Information Coordinating Center (NHLBI‐BioLINCC) for the opportunity to access these data. This manuscript is partially the result of work supported with resources and use of facilities of the Minneapolis Veterans Affairs Health Care System. The contents do not represent the views of the U.S. Department of Veterans Affairs or the United States Government. This study was partially supported by an investigator‐initiated grant from Medtronic External Research Program.
Publisher Copyright:
© 2021 Wiley Periodicals LLC. This article has been contributed to by US Government employees and their work is in the public domain in the USA.
PubMed: MeSH publication types
- Journal Article
- Research Support, Non-U.S. Gov't
