Kelly Ryan, Buth Karen J, Heimrath Olivier, Basta Magdy, Legare Jean-Francois
Departments of Surgery, Dalhousie University, Halifax, Nova Scotia.
Open Cardiovasc Med J. 2010 Nov 16;4:206-13. doi: 10.2174/1874192401004010206.
The objective of this study was to identify and examine ICD utilization in a large group of eligible coronary artery bypass grafting (CABG) patients with impaired left ventricular function.
We conducted a retrospective study of ICD eligible patients who had previously undergone CABG surgery between March 1, 1995 and June 30, 2008 at a single tertiary care institution. All patients with a pre-operative left ventricular ejection fraction (LVEF) ≤ 35% were considered ICD eligible. The events of interest were ICD implantation and mortality, based on administrative data linkage.
A total of 1,169 out of 11,931 CABG patients operated on during the same period had LVEF ≤ 35% and were defined as ICD eligible (mean EF = 27.3% +/- 6.4%). Of these eligible patients, only 101 received an ICD during follow-up (8.6%). The median time to implant was 255 days (14-1078). The single variable that independently predicted eventual ICD implantation was a history of arrhythmia (OR = 7.4; CI, 4.4-12.2). The variables that predicted not having an ICD implanted during follow-up included the need for urgent CABG (OR = 0.5; CI, 0.2-0.9), age > 70 years (OR = 0.5; CI, 0.3-0.8), female gender (OR = 0.2; CI,0.1-0.6), or having chronic obstructive lung disease (OR = 0.5; CI,0.3-0.8). As a data validation step, a series of consecutive patient records were reviewed (n=80) showing that fewer than 23% underwent appropriate follow-up EF assessment post revascularization.
Our findings suggest that CABG patients with ischemic cardiomyopathy have low rates of ICD utilization. This is particularly evident among females and elderly patients. Furthermore our data suggests that few patients post-revascularization undergo follow-up EF assessment despite current guidelines likely contributing to the low rates of ICD utilization.
本研究的目的是确定并检查一大组左心室功能受损的符合植入心脏除颤器（ICD）条件的冠状动脉旁路移植术（CABG）患者中ICD的使用情况。
我们对1995年3月1日至2008年6月30日期间在一家三级医疗机构接受过CABG手术的符合ICD植入条件的患者进行了一项回顾性研究。所有术前左心室射血分数（LVEF）≤35%的患者被视为符合ICD植入条件。基于行政数据关联，关注的事件为ICD植入和死亡率。
同期接受CABG手术的11931例患者中，共有1169例LVEF≤35%，被定义为符合ICD植入条件（平均EF = 27.3%±6.4%）。在这些符合条件的患者中，随访期间只有101例接受了ICD植入（8.6%）。植入的中位时间为255天（14 - 1078天）。唯一能独立预测最终ICD植入的变量是心律失常病史（OR = 7.4；CI，4.4 - 12.2）。预测随访期间未植入ICD的变量包括需要紧急CABG（OR = 0.5；CI，0.2 - 0.9）、年龄>70岁（OR = 0.5；CI，0.3 - 0.8）、女性（OR = 0.2；CI，0.1 - 0.6）或患有慢性阻塞性肺疾病（OR = 0.5；CI，0.3 - 0.8）。作为数据验证步骤，审查了一系列连续的患者记录（n = 80），结果显示，血运重建后接受适当的随访EF评估的患者少于23%。
我们的研究结果表明，患有缺血性心肌病的CABG患者ICD使用率较低。这在女性和老年患者中尤为明显。此外，我们的数据表明，尽管有现行指南，但血运重建后的患者很少接受随访EF评估，这可能是ICD使用率低的原因。
