COMPARISON OF OUTCOME OF IMPLANTABLE CARDIOVERTER-DEFIBRILLATOR IMPLANTATION IN PATIENTS WITH SEVERE VERSUS MODERATELY SEVERE LEFT-VENTRICULAR DYSFUNCTION SECONDARY TO ATHEROSCLEROTIC CORONARY-ARTERY DISEASE

This study was undertaken to assess the feasibility and clinical outco me of implantable cardioverter-defibrillators (ICDs) among patients wi th coronary artery disease and left ventricular ejection fraction (LVE F) of < 20%. The morbidity, mortality, and the long-term survival of 1 17 patients with LVEF of < 20% (group 1) were compared with 321 patien ts with LVEF of 20% to 40% (group 2). Mortality in the first 30 days a fter ICD implantation was 0% for group 1 and 0.6% in group 2. Actuaria l survival (all cause) at the end of 2, 4, and 5 years were 83%, 70%, and 62%, respectively, in group 1 and 90%, 80%, and 71% in group 2 (p = 0.05). Fifty-five patients (47%) in group 1 and 126 patients (39%) i n group 2 received appropriate shocks during follow up. Among the pati ents in group I,the overall survival at 2 years after an appropriate s hock from an ICD was 92% for patients < 60 years of age, 77% for patie nts ages 60 to 69, and 53% for patients > 70 years old. Although the o verall survival of patients in group 1 was slightly lower compared wit h those in group 2, in a multivariate analysis, the EF was not an inde pendent predictor of poor survival. The ICD can be implanted with acce ptable operative morbidity and mortality in selected patients with LVE F of < 20%. (C) 1997 by Excerpta Medica, Inc.