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Open Access Research article

Improved survival of patients with coronary artery disease and low ejection fraction with ICD implantation versus conventional therapy in a real world survey

Timo Aschenbrenner1, Johannes Brockmeier1, Peter Bramlage2*, Rolf Fimmers3, Alessandro Cuneo14, Stefan Hochreuther1, Claudia Zemmrich2 and Ulrich Tebbe1

Author Affiliations

1 Department I - Cardiology, Angiology, Intensive Care Medicine, Klinikum Lippe-Detmold, Röntgenstrasse 18, 32756, Detmold, Germany

2 Institut für Pharmakologie und präventive Medizin, Mahlow, Germany

3 Department of Biometry and Medical Statistics, University of Bonn, Bonn, Germany

4 Abteilung für Kardiologie, Asklepios Klinik St-Georg, Hamburg, Germany

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BMC Research Notes 2012, 5:382  doi:10.1186/1756-0500-5-382

Published: 27 July 2012

Abstract

Background

Coronary artery disease (CAD) is associated with an increased risk for sudden cardiac death. Randomized controlled trials have shown that implantable cardioverter defibrillators (ICD) improve life expectancy unless they are implanted within the first days after an acute myocardial infarction and guidelines recommend their use. We aimed to validate that these results also apply to patients of a typical community hospital in Germany.

Methods

This was a retrospective analysis of patients undergoing coronary angiography in the Lippe-Detmold Hospital between 2003 and 2006. They had to have significant CAD and an ejection fraction (EF) ≤ 35% and no acute myocardial infarction within 28 days of implantation and no history of ventricular fibrillation.

Results

213 patients were included; 70 of which received an ICD. Patients with an ICD implantation were younger (64.8 ± 9.9 vs. 67.9 ± 9.8 years; p = 0.034), had single vessel CAD more frequently (22.9 vs. 11.2%; p = 0.025) and a lower EF (26.7 ± 6.3 vs. 29.1 ± 4.6%; p = 0.006). Hospital readmissions were comparable between the ICD and the control group (68.6 vs. 72.0%; p = 0.602). ICD therapy was associated with a considerable survival benefit compared to conventional therapy (HR 0.52; 95%CI 0.29-0.93; p = 0.027) in a Cox-Proportional Hazards Regression analysis.

Conclusions

Appreciating the potential limitations of retrospective studies, we found that ICD use was associated with improved survival in patients with significant CAD and an EF <= 35% typical for a large tertiary hospital.

Keywords:
Implantable cardioverter defibrillator; Cohort study; Myocardial infarction