Electrophysiological Effects of Late Percutaneous Coronary Intervention for Infarct-Related Coronary Artery Occlusion

Rashba, Eric J.; Lamas, Gervasio A.; Couderc, Jean‐Philippe; Hollist, Sharri M.; Džavík, Vladimir; Rużyłło, Witold; Fridrich, Viliam; Buller, Christopher E.; Forman, Sandra; Kufera, Joseph A.; Carvalho, Antônio Carlos; Hochman, Judith S.

doi:10.1161/circulationaha.108.808626

Cited by 23 publications

(9 citation statements)

References 28 publications

(38 reference statements)

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“…67 There were no significant differences in heart rate variability, timedomain signal-averaged ECG, or T-wave variability parameters (all surrogate markers of ventricular instability) between either group at 30 days and 1 year after the AMI, which is consistent with the lack of clinical benefit from PCI in stable patients after AMI with persistently occluded infarct-related arteries in the main OAT study.…”

Section: Ventricular Arrhythmias After Myocardial Infarctionsupporting

confidence: 72%

Cardiac arrhythmias and pacing

Liew¹

2012

Srce i krvni sudovi

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Clinical trials i n the past 2 years, a number of landmark clinical trials have been published which further our understanding and clinical management of patients with atrial fibrillation (AF). Two of the major goals in the treatment of this condition include reducing progression or recurrence of the arrhythmia and decreasing the risk of cardiovascular events, thereby improving quality of life and decreasing morbidity. Following on from a large body of evidence from preclinical studies, small clinical trials and meta-analyses suggesting that blockade of the renin-angiotensin system has beneficial effects on the pathophysiology of AF, 1 two large multicentre, placebo-controlled, randomised trials were conducted to determine the effects of angiotensin II receptor blockers (ARBs) on AF.The first of these trials, published in 2009, tested the hypothesis that the ARB valsartan could reduce the recurrence of AF in patients with underlying cardiovascular disease, diabetes or left atrial enlargement and a history of documented AF, in addition to established treatments. 2A total of 1442 patients were enrolled into the study-722 assigned to the valsartan group (target dose 320 mg) and 720 to the placebo group. The investigators found that treatment with valsartan had no significant effect on AF recurrence (AF recurrence 51.4% in the valsartan group and 52.1% in the placebo group, p=0.73) over a relatively short follow-up period of 1 year.The second large ARB randomised controlled trial (RCT) published this year evaluated whether irbesartan would reduce the risk of cardiovascular events in patients with AF.3 Patients with a history of risk factors for stroke and a systolic blood pressure of at least 110 mm Hg were randomly assigned to receive either irbesartan (target dose of 300 mg once daily) or placebo. Patients for this study were already enrolled in one of two other AF trials looking at clopidogrel plus aspirin versus aspirin alone or versus oral anticoagulants. The investigators found that irbesartan did not reduce cardiovascular events or hospitalisation rates for AF (total of 9016 enrolled with a mean follow-up of 4.1 years) and that, not surprisingly, more patients in the irbesartan group had symptomatic hypotension and renal dysfunction than those in the placebo group.Although the main findings from both of these large RCTs were negative, it should be noted that they were secondary prevention studies-that is, patients already had established AF, and also had more advanced stages of disease (over 80% of patients in both studies had a history of persistent or permanent AF), implying that the substrate for AF was already well established in both study groups. It might be argued that blockade of the renin-angiotensin system may be a more effective strategy if performed earlier during the natural history of the disease or even before AF develops (ie, primary prevention), since ACE inhibitors and ARBs may prevent, but not necessarily reverse, the electrical and structural remodelling that leads to the development and p...

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Section: Ventricular Arrhythmias After Myocardial Infarctionsupporting

confidence: 72%

Cardiac arrhythmias and pacing

Liew¹

2012

Srce i krvni sudovi

View full text Add to dashboard Cite

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“…67 There were no significant differences in heart rate variability, time-domain signal-averaged ECG, or T-wave variability parameters (all surrogate markers of ventricular instability) between either group at 30 days and 1 year after the AMI, which is consistent with the lack of clinical benefit from PCI in stable patients after AMI with persistently occluded infarct-related arteries in the main OAT study.…”

Section: Ventricular Arrhythmias and Sudden Cardiac Deathsupporting

confidence: 72%

Almanac 2011: Cardiac Arrhythmias and Pacing. The National Society Journals Present Selected Research that has Driven Recent Advances in Clinical Cardiology

Liew

2011

Mater Sociomed

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“…Although previous studies showed an improvement in arrhythmic markers after late reperfusion of an infarct-related artery, 28,29 more recently, Rashba et al, 30 in a substudy of the OAT (Occluded Artery Trial), found no differences in heart rate variability between percutaneous coronary intervention with stenting of a persistently occluded infarct-related artery and medical treatment. However, this study included patients with subacute MI and a mean LVEF of 47% compared to an LVEF of 30% in the present study population with only 50% of the patients with chronic MI and 30% with Q waves in the CTO territory.…”

Section: Nombela-franco Et Al Vacto Primary Study 151mentioning

confidence: 93%

Ventricular Arrhythmias Among Implantable Cardioverter-Defibrillator Recipients for Primary Prevention

Nombela‐Franco

Mitroi

Fernández‐Lozano

et al. 2012

Circ: Arrhythmia and Electrophysiology

141

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Background-An implantable cardioverter-defibrillator (ICD) is the therapy of choice for primary prevention in patients with ischemia who are at risk for sudden cardiac death (SCD). One third of patients with significant coronary disease have chronic total coronary occlusion (CTO), which is associated with long-term mortality in patients with previous myocardial infarction. However, the impact of CTO on the occurrence of ventricular arrhythmias and long-term mortality in ICD recipients remains unknown. Methods and Results-All consecutive patients with coronary artery disease receiving ICD therapy for the prevention of SCD were included in the study. Among other characteristics, the existence of CTO was assessed. During follow-up, the occurrence of appropriate device delivery because of ventricular arrhythmias as well as mortality were noted. A total of 162 patients (mean age, 62Ϯ9 years; 93% men) with an ICD were included and followed for a median of 26 months (interquartile range, 12-42). At least 1 CTO was present in 71 (44%) patients. Appropriate device therapy was detected in 18% of the patients during the follow-up. The presence of CTO was associated with higher ventricular arrhythmia and mortality rates (log-rank test, Ͻ0.01). Multivariable analysis revealed that CTO was independently associated with appropriate ICD intervention (hazard ratio, 3.5; Pϭ0.003). Conclusions-In patients with ischemic heart disease receiving ICDs for primary prevention of SCD, CTO is an independent predictor for the occurrence of ventricular arrhythmias and has an adverse impact on long-term mortality. (Circ Arrhythm Electrophysiol. 2012;5:147-154.)

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Electrophysiological Effects of Late Percutaneous Coronary Intervention for Infarct-Related Coronary Artery Occlusion

Cited by 23 publications

References 28 publications

Cardiac arrhythmias and pacing

Cardiac arrhythmias and pacing

Almanac 2011: Cardiac Arrhythmias and Pacing. The National Society Journals Present Selected Research that has Driven Recent Advances in Clinical Cardiology

Ventricular Arrhythmias Among Implantable Cardioverter-Defibrillator Recipients for Primary Prevention

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