Implantable Cardioverter Defibrillator Utilization and Mortality Among Patients ≥ 65 Years of Age with a Low Ejection Fraction Following Coronary Revascularization.
The purpose of this analysis was to assess implantable cardioverter-defibrillator (ICD) utilization and its association with mortality among patients ≥ 65 years of age following coronary revascularization. Patients in the NCDR Chest Pain-Myocardial Infarction (MI) Registry who presented with MI between 1/2/09-12/31/16, had a left ventricular (LV) ejection fraction (EF) ≤ 35% and underwent in-hospital revascularization (10,014 percutaneous coronary intervention (PCI) and 1,647 coronary artery bypass grafting (CABG)) were linked with Medicare claims to determine rates of 1-year ICD implantation. The association between ICD implantation and 2-year mortality was assessed. Of 11,661 included patients, an ICD was implanted in 1,234 (10.6%) within 1 year of revascularization (1063 (10.6%) PCI and 171 (10.4%) CABG). Among PCI-treated patients, in-hospital ventricular arrhythmia (aHR 1.60, 95% CI 1.34-1.92), 2-week cardiology follow-up (aHR 1.48, 95% CI 1.29-1.70), readmission for heart failure (HF) (aHR 3.21, 95% CI 2.73-3.79), and readmission for MI (aHR 2.18, 95% CI 1.66-2.85) were positively associated with ICD implantation. Among CABG-treated patients, in-hospital ventricular arrhythmia (aHR 2.33, 95% CI 1.39-3.91) and HF readmission (aHR 3.14, 95% CI 1.96-5.04) were positively associated with ICD implantation. Women were less likely to receive an ICD, regardless of the revascularization strategy. ICD implantation was associated with lower 2-year mortality (aHR 0.74, 95% CI 0.63-0.86). In conclusion, only 1 in 10 Medicare patients with low EF received an ICD within 1 year following revascularization. Contact with the healthcare system following discharge was associated with higher likelihood of ICD implantation. ICD implantation was associated with lower mortality following revascularization for MI.