Effect of surgical revascularization in patients with coronary artery disease and ventricular tachycardia or fibrillation in the Antiarrhythmics Versus Implantable Defibrillators (AVID) Registry.

BACKGROUND Patients who undergo resuscitation from near-fatal ventricular arrhythmias often have significant coronary artery disease, and revascularization has been shown to reduce myocardial ischemia and cardiac arrest episodes in this patient population. The magnitude of benefit attributed to revascularization has varied by study, and the use of adjunct implantable cardioverter defibrillator (ICD) therapy has not been well-characterized. METHODS AND RESULTS The Antiarrhythmics Versus Implantable Defibrillators (AVID) registry included 3117 patients with life-threatening ventricular arrhythmias, of whom 2321 (77%) had documented coronary artery disease and 281 (17%) underwent a coronary artery bypass grafting revascularization procedure after the index event. Patients who underwent a revascularization procedure were younger, had a lower incidence rate of prior myocardial infarction and ventricular arrhythmia, had a higher left ventricular ejection fraction, had less congestive heart failure, and were more likely to have had ventricular fibrillation as the presenting arrhythmia. Patients who underwent revascularization had a better survival rate than did those who did not undergo such a procedure after the index event, and adjustment for differing baseline patient covariates did not alter the relative survival rate benefit. Further, ICD implantation offered a similar survival rate advantage to those patients in the AVID registry with coronary artery disease independent of revascularization. CONCLUSION Coronary revascularization in the AVID registry patients with coronary artery disease effected a survival rate benefit that was not attributable to differences in baseline patient characteristics. The benefit of ICD on patient survival rate was not attenuated by a revascularization procedure.

[1]  P. Poole‐Wilson,et al.  Acute coronary findings at autopsy in heart failure patients with sudden death: results from the assessment of treatment with lisinopril and survival (ATLAS) trial. , 2000, Circulation.

[2]  M Gent,et al.  Canadian implantable defibrillator study (CIDS) : a randomized trial of the implantable cardioverter defibrillator against amiodarone. , 2000, Circulation.

[3]  K. Lee,et al.  A randomized study of the prevention of sudden death in patients with coronary artery disease. Multicenter Unsustained Tachycardia Trial Investigators. , 1999, The New England journal of medicine.

[4]  Y. Rosenberg,et al.  Design and results of the antiarrhythmics vs implantable defibrillators (AVID) registry. The AVID Investigators. , 1999, Circulation.

[5]  P. J. Wang,et al.  Evaluation of coronary revascularization to prevent tachycardia recurrences in survivors of ventricular fibrillation. , 1999, The American journal of cardiology.

[6]  C. Bierman Book Review Allergy Second edition. Edited by Allen P. Kaplan. 896 pp., illustrated. Philadelphia, W.B. Saunders, 1997. $120. 0-7216-4974-2 , 1997 .

[7]  Bigger Jt,et al.  Prophylactic use of implanted cardiac defibrillators in patients at high risk for ventricular arrhythmias after coronary-artery bypass graft surgery , 1997 .

[8]  M. Keller,et al.  A comparison of antiarrhythmic-drug therapy with implantable defibrillators in patients resuscitated from near-fatal ventricular arrhythmias. , 1997, The New England journal of medicine.

[9]  A Hallstrom,et al.  Comparison of clinical characteristics and frequency of implantable defibrillator use between randomized patients in the Antiarrhythmics Vs Implantable Defibrillators (AVID) trial and nonrandomized registry patients. , 1997, The American journal of cardiology.

[10]  A. Moss,et al.  Improved survival with an implanted defibrillator in patients with coronary disease at high risk for ventricular arrhythmia. Multicenter Automatic Defibrillator Implantation Trial Investigators. , 1996, The New England journal of medicine.

[11]  M. Niebauer,et al.  Incidence of implantable defibrillator discharges after coronary revascularization in survivors of ischemic sudden cardiac death. , 1995, American heart journal.

[12]  M. Domanski,et al.  Antiarrhythmics Versus Implantable Defibrillators (AVID)--rationale, design, and methods. , 1995, The American journal of cardiology.

[13]  A. Manolis,et al.  Effects of Coronary Artery Bypass Grafting on Ventricular Arrhythmias: Results with Electrophysiological Testing and Long‐Term Follow‐Up , 1993, Pacing and clinical electrophysiology : PACE.

[14]  W. Weaver,et al.  Influence of coronary bypass surgery on subsequent outcome of patients resuscitated from out of hospital cardiac arrest. , 1992, Journal of the American College of Cardiology.

[15]  R. O'rourke Role of myocardial revascularization in sudden cardiac death. , 1992, Circulation.

[16]  S. Gottlieb,et al.  Sudden death during ambulatory electrocardiographic monitoring. , 1991, The American journal of cardiology.

[17]  J. Ruskin,et al.  Surgical coronary revascularization in survivors of prehospital cardiac arrest: its effect on inducible ventricular arrhythmias and long-term survival. , 1990, Journal of the American College of Cardiology.

[18]  B. Lerman,et al.  Coronary artery bypass grafting in patients with ventricular fibrillation. , 1989, The Annals of thoracic surgery.

[19]  F. Harrell,et al.  Surgical survival benefits for coronary disease patients with left ventricular dysfunction. , 1988, Circulation.

[20]  J. Ruskin,et al.  Out-of-hospital cardiac arrest. Use of electrophysiologic testing in the prediction of long-term outcome. , 1988, The New England journal of medicine.

[21]  J. Fleiss,et al.  Mechanism of death and prevalence of myocardial ischemic symptoms in the terminal event after acute myocardial infarction. , 1988, The American journal of cardiology.

[22]  B. Gersh,et al.  The effect of medical and surgical treatment on subsequent sudden cardiac death in patients with coronary artery disease: a report from the Coronary Artery Surgery Study. , 1986, Circulation.

[23]  D. Tresch,et al.  Long-term follow-up of survivors of prehospital sudden cardiac death treated with coronary bypass surgery. , 1985, American heart journal.

[24]  A. Castellanos,et al.  Long-term survival after prehospital cardiac arrest: analysis of outcome during an 8 year study. , 1984, Circulation.

[25]  M J Davies,et al.  Thrombosis and acute coronary-artery lesions in sudden cardiac ischemic death. , 1984, The New England journal of medicine.

[26]  H. L. Stone,et al.  Autonomic mechanisms in ventricular fibrillation induced by myocardial ischemia during exercise in dogs with healed myocardial infarction. An experimental preparation for sudden cardiac death. , 1984, Circulation.

[27]  J. Ruskin,et al.  Electrophysiologic studies before and after myocardial revascularization in patients with life-threatening ventricular arrhythmias. , 1983, The American journal of cardiology.

[28]  J. Kalbfleisch,et al.  The Statistical Analysis of Failure Time Data , 1980 .

[29]  W. Weaver,et al.  Angiographic findigs and prognostic indicators in patients resuscitated from sudden cardiac death. , 1976, Circulation.

[30]  D. Cox Regression Models and Life-Tables , 1972 .

[31]  E. Kaplan,et al.  Nonparametric Estimation from Incomplete Observations , 1958 .