THE ROLE OF CORONARY REVASCULARIZATION IN RECIPIENTS OF AN IMPLANTABLE CARDIOVERTER-DEFIBRILLATOR

The impact of adjuvant coronary revascularization was studied in a gro up of 138 recipients of an implantable cardioverter-defibrillator, all of whom had ischemic heart disease as the cause of their arrhythmias. Patients chosen for revascularization had more severe anatomic, sympt omatic, or physiologic evidence of active ischemia, There were no oper ative deaths among 23 patients who actually underwent coronary artery bypass combined with cardioverter-defibrillator implantation; however, operative mortality by the intention-to-treat principle was 8% (2/25) . Total cardiac survival was better for patients who underwent revascu larization than for those patients who had ''high-risk'' characteristi cs and did not undergo revascularization. Stratified subgroup analysis demonstrated significant survival advantages favoring revascularizati on in patients with three-vessel or left main coronary artery disease, class III or IV angina, and an ejection fraction greater than 25%, Mu ltivariate analysis revealed that low ejection fraction and left main coronary artery disease were independent predictors of decreased survi val.