Factors determining long-term outcomes and survival in patients with coronary artery disease and ventricular tachyarrhythmias: A single center experience

A Single-Center Experience. The influence, after ICD implantation, of conco mitant CABG, angioplasty, and other antiischemic therapeutic interventions, like treatment with beta -blockers, on outcome and mortality of patients w ith VT or VF due to CAD remains uncertain. The univariate and multivariate risks of recurrence of ventricular arrhythmias requiring ICD interventions or death associated with baseline clinical and functional variables were st udied in 160 consecutive patients with CAD of whom 30 underwent CABG or ang ioplasty less than or equal to 2 weeks before ICD implantation. ICD interve ntions occurred in 98 (61%) patients over a mean follow-up of 1,065 days. I n univariate and multivariate analysis, VT as the presenting arrhythmia was the only clinical factor predictive of recurrences. Treatment with beta -b lockers at hospital discharge reduced the probability of recurrences. Kapla n-Meier analysis confirmed the effect of beta -blockers (P < 0.005) and of VT as the presenting arrhythmia (P < 0.01). Overall mortality was 61% (29/1 60). in multivariate analysis a low ejection fraction (less than or equal t o 0.20) and omission of angiotensin-converting enzyme inhibitors at dischar ge were associated with excess mortality. In Kaplan-Meier analysis, a low e jection fraction (borderline between 0.30 and 0.21, significant < 0.21) wet s the single predictor of mortality. Revascularization by CABG or angioplas ty had no influence on ventricular arrhythmia recurrences or survival. Duri ng long-term follow-up, VT as the presenting arrhythmia and the omission of <beta>-blocker therapy were associated with excess recurrences of ventricu lar arrhythmias after ICD implantation. In contrast, survival depended prim arily on left ventricular function at discharge. Revascularization did not prevent recurrences of arrhythmias and had no significant effect on surviva l in the small group of patients who underwent CABG or angioplasty.