RESUMEN
BACKGROUND: There is clear evidence that patients with prior myocardial infarction and a reduced ejection fraction benefit from implantation of a cardioverter-defibrillator (ICD). It is unclear whether this benefit is altered by whether or not revascularization is performed prior to ICD implantation. METHODS: This was a retrospective cohort study following patients who underwent ICD implantation from 2002 to 2014. Patients with ischemic cardiomyopathy and either primary or secondary prevention ICDs were selected for inclusion. Using the electronic medical record, cardiac catheterization data, revascularization status (percutaneous coronary intervention or coronary bypass surgery) were recorded. The outcomes were mortality and ventricular arrhythmia. RESULTS: There were 606 patients included in the analysis. The mean age was 66.3 ± 10.1 years, 11.9% were women, and the mean LVEF was 30.5 ± 12.0, 58.9% had a primary indication for ICD, 82.0% of the cohort had undergone coronary catheterization prior to ICD implantation. In the overall cohort, there were fewer mortality and ventricular arrhythmia events in patients who had undergone prior revascularization. In patients who had an ICD for secondary prevention, revascularization was associated with a decrease in mortality (HR 0.46, 95% CI (0.24, 0.85) p = 0.015), and a trend towards fewer ventricular arrhythmia (HR 0.62, 95% CI (0.38, 1.00) p = 0.051). There was no association between death or ventricular arrhythmia with revascularization in patients with primary prevention ICDs. CONCLUSION: Revascularization may be beneficial in preventing recurrent ventricular arrhythmia, and should be considered as adjunctive therapy to ICD implantation to improve cardiovascular outcomes.
Asunto(s)
Arritmias Cardíacas/prevención & control , Cardiomiopatías/terapia , Puente de Arteria Coronaria , Cardioversión Eléctrica , Isquemia Miocárdica/terapia , Intervención Coronaria Percutánea , Anciano , Arritmias Cardíacas/etiología , Arritmias Cardíacas/mortalidad , Cardiomiopatías/etiología , Cardiomiopatías/mortalidad , Toma de Decisiones Clínicas , Puente de Arteria Coronaria/efectos adversos , Puente de Arteria Coronaria/mortalidad , Desfibriladores Implantables , Cardioversión Eléctrica/efectos adversos , Cardioversión Eléctrica/instrumentación , Cardioversión Eléctrica/mortalidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Isquemia Miocárdica/complicaciones , Isquemia Miocárdica/mortalidad , Intervención Coronaria Percutánea/efectos adversos , Intervención Coronaria Percutánea/mortalidad , Prevención Primaria , Sistema de Registros , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Prevención Secundaria , Factores de Tiempo , Resultado del TratamientoRESUMEN
Influenza induced cardiogenic shock is rare and the majority of reported cases are a result of Influenza A myocarditis. We describe a patient with Influenza B who developed myocarditis and cardiogenic shock, with no known pre-existing heart disease. The patient's disease progressed to include rhabdomyolysis, compartment syndrome, renal failure, and pneumonia. He was successfully managed with Oseltamivir, renal replacement therapy, antimicrobials and intubation. This case is notable due to the rarity of influenza B induced cardiogenic shock and reinforces the importance of recognition and treatment.