Identifying the high risk patient with coronary artery disease--is ejection fraction all you need?

Area of Science:

• Cardiology
• Clinical Trials
• Preventive Medicine

Background:

• Sudden cardiac death percentage is increasing despite overall cardiovascular disease death reduction.
• Randomized clinical trials have assessed antiarrhythmic therapy for chronic coronary disease with abnormal left ventricular function.
• Implantable cardioverter-defibrillators (ICDs) show mortality reduction compared to antiarrhythmic drugs or no therapy.

Purpose of the Study:

• To review the potential of left ventricular ejection fraction (EF) alone for risk stratification.
• To evaluate the efficacy of other variables for risk stratification in primary prevention.
• To address the lack of information on cost-effective ICD assignment for primary prevention.

Main Methods:

• Review of randomized clinical trials evaluating antiarrhythmic therapy.
• Analysis of factors influencing ICD efficacy.
• Examination of left ventricular ejection fraction (EF) as a risk factor.

Main Results:

• A majority of trials demonstrated ICDs reduce mortality compared to other therapies.
• Reduced left ventricular ejection fraction (EF) was a common entry criterion but not always the sole one.
• Prognostic significance of various factors impacting ICD efficacy has been shown.

Conclusions:

• Current studies lack data to determine the most cost-effective ICD use for primary prevention.
• Further research is needed to understand the relative efficacy of different risk factors for ICD implantation.
• Left ventricular ejection fraction (EF) alone and other variables require further investigation for risk stratification.