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Wearable cardioverter defibrillators improved outcomes after PCI
Patients with low left ventricular ejection fraction had higher early compared with late mortality after coronary revascularization, particularly after PCI; however, this hazard was less marked in those who were using wearable cardioverter defibrillators, study findings have suggested.
To examine mortality risk in post-revascularization patients with LVEF ≤35% compared with those discharged with a wearable cardioverter defibrillator (WCD), researchers enrolled hospital survivors after CABG or PCI into a retrospective observational parallel cohort study from registries at the Cleveland Clinic and national WCD registries.
Early mortality hazard was higher among 4,149 patients discharged without a defibrillator compared with 809 with WCDs. Ninety-day mortality rates post-CABG were 7% vs. 3% (P=.03) compared with post-PCI 90-day mortality rates of 10% vs. 2% (P<.0001).
WCD use was associated with less risk of long-term mortality — first in the total cohort (39%; P<.0001) and next in both the post-CABG (38%; P=.048) and post-PCI (57%; P<.0001) cohorts.
Propensity-matched analyses revealed that WCD use was associated with lower mortality for post-CABG patients (58%; P=.002) and for post-PCI patients (67%; P<.0001).
Researchers noted that CABG and PCI demonstrated significant risk of death early after coronary revascularization procedures in patients with LV dysfunction, a time that likely carries risk of arrhythmic and non-arrhythmic death.
The study findings, the researchers wrote, “emphasize the need to address the early mortality risk after coronary revascularization. Although results suggest consideration for use of a WCD in particularly high-risk patients during the period of recovery after PCI or CABG prior to reassessment of LV function and indications for ICD implantation, whether WCD use would result in mortality reduction during this early period should be tested in a randomized clinical trial.”
Disclosure: Zishiri reports no relevant financial disclosures.