Characteristics of Coronary Artery Involvement and Probability of Appropriate Discharges of Cardioverter-Defibrillator Implanted for Primary Prevention of Sudden Cardiac Death
Purpose: to assess characteristics of involvement of coronary vascular bed in patients with ischemic heart disease and cardioverter defibrillator (CD) implanted for primary prevention of sudden cardiac death (SCD) with and without history of appropriate implantable (I) CD therapies. Material and methods. We examined 64 survivors of myocardial infarction (MI) (60 men, 4 women) with CD implanted for primary prevention of SCD. Mean duration of follow up after CD implantation was 19.0±2.0 months. Patients were divided into 2 groups: with (n = 26, group 1) and without (n = 38, group 2) appropriate ICD therapies during follow-up. Coronary angiography data (on presence of hemodynamically significant lesions in main stem [MS], anterior interventricular, circumflex branches [CB] of left coronary artery [LCA], and in right coronary artery [RCA]) and data of transthoracic echocardiography (on localization of akinesia and dyskinesia zones) obtained in these groups were compared. Results. Lesions in anterior interventricular branch were found in 25 (96%) and 28 (74%) patients in groups 1 and 2, respectively. Frequencies of involvement of other coronary arteries were not significantly different: MS LCA - 7 (27%) vs 5 (13%), р = 0.14; CB - 17 (65%) vs. 18 (47%), р = 0.24; RCA - 16 (62%) vs. 17 (45%), р = 0.29) in groups 1 and 2, respectively. There were no significant differences between groups in frequencies of various localizations of MI as detected by echocardiography. Conclusion. Hemodynamically significant involvement of anterior intraventricular branch of LCA is a predictor of any appropriate ICD therapy.