Effect of implantable cardioverter‐defibrillators in patients with non‐ischaemic systolic heart failure and concurrent coronary atherosclerosis

• Published in: ESC Heart Failure 2022-04, Vol.9 (2), p.1287-1293
• Main Authors: Byrne, Christina, Ahlehoff, Ole, Elming, Marie Bayer, Pedersen, Frants, Pehrson, Steen, Nielsen, Jens C., Eiskjær, Hans, Videbæk, Lars, Svendsen, Jesper Hastrup, Haarbo, Jens, Thøgersen, Anna Margrethe, Køber, Lars, Thune, Jens Jakob
• Format: Article
• Language: English
• Subjects: Atherosclerosis; Cardiovascular disease; Confidence intervals; Coronary Artery Disease - complications; Coronary atherosclerosis; Coronary vessels; Death, Sudden, Cardiac - prevention & control; Defibrillators; Defibrillators, Implantable; Diabetes; Ejection fraction; Etiology; Gender; Heart failure; Heart Failure, Systolic - etiology; Humans; Hypertension; Implantable cardioverter defibrillator; Ischemia; Male; Medical imaging; Mortality; Non‐ischaemic systolic heart failure; Original; Patients; Peptides; Software; Stroke Volume; Tomography; Vein & artery diseases; Ventricular Function, Left
• ISSN: 2055-5822; 2055-5822
• DOI: 10.1002/ehf2.13810

Aims Prophylactic implantable cardioverter‐defibrillators (ICD) reduce mortality in patients with ischaemic heart failure (HF), whereas the effect of ICD in patients with non‐ischaemic HF is less clear. We aimed to investigate the association between concomitant coronary atherosclerosis and mortality in patients with non‐ischaemic HF and the effect of ICD implantation in these patients. Methods and results Patients were included from DANISH (Danish Study to Assess the Efficacy of Implantable Cardioverter Defibrillators in Patients with Non‐Ischaemic Systolic Heart Failure on Mortality), randomizing patients to ICD or control. Study inclusion criteria for HF were left ventricular ejection fraction ≤ 35% and increased levels (>200 pg/mL) of N‐terminal pro‐brain natriuretic peptide. Of the 1116 patients from DANISH, 838 (75%) patients had available data from coronary angiogram and were included in this subgroup analysis. We used Cox regression to assess the relationship between coronary atherosclerosis and mortality and the effect of ICD implantation. Of the included patients, 266 (32%) had coronary atherosclerosis. Of these, 216 (81%) had atherosclerosis without significant stenoses, and 50 (19%) had significant stenosis. Patients with atherosclerosis were significantly older {67 [interquartile range (IQR) 61–73] vs. 61 [IQR 54–68] years; P