Mechanisms of death in the CABG Patch Trial : A randomized Trial of implantable cardiac Defibrillator prophylaxis in patients at high risk of death after coronary artery bypass graft surgery

• Published in: Circulation (New York, N.Y.) Vol. 99; no. 11; pp. 1416 - 1421
• Main Authors: BIGGER, J. T, WHANG, W, ROTTMAN, J. N, KLEIGER, R. E, GOTTLIEB, C. D, NAMEROW, P. B, STEINMAN, R. C, ESTES, N. A. M. III
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 23.03.1999
• Subjects: Anti-Arrhythmia Agents - therapeutic use; Arrhythmias, Cardiac - drug therapy; Arrhythmias, Cardiac - mortality; Arrhythmias, Cardiac - therapy; Arteriosclerosis - mortality; Biological and medical sciences; Cause of Death; Cerebrovascular Disorders - mortality; Cohort Studies; Coronary Artery Bypass; Coronary Disease - mortality; Death, Sudden, Cardiac - epidemiology; Death, Sudden, Cardiac - prevention & control; Defibrillators, Implantable; Dyspnea - epidemiology; Female; Heart Failure - epidemiology; Hospitalization - statistics & numerical data; Humans; Life Tables; Male; Medical sciences; Neoplasms - mortality; Postoperative Complications - drug therapy; Postoperative Complications - mortality; Postoperative Complications - prevention & control; Postoperative Complications - therapy; Proportional Hazards Models; Risk; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Human; Intensive cardiocirculatory care; Prognosis; Arrhythmia; Mortality; Instrumentation therapy; Cardiovascular disease; Treatment; Aortocoronary; Bypass; Follow up study; Implanted; Heart disease; Surgery; Defibrillation; Defibrillator
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/01.CIR.99.11.1416

The CABG Patch trial compared prophylactic implantable cardiac-defibrillator (ICD) implantation with no antiarrhythmic therapy in coronary bypass surgery patients who had a left ventricular ejection fraction <0.36 and an abnormal signal-averaged ECG. There were 102 deaths among the 446 ICD group patients and 96 deaths among the 454 control group patients, a hazard ratio of 1.07 (P=0.63). The mechanisms of death were classified, and hypotheses were tested about the effects of ICD therapy on arrhythmic and nonarrhythmic cardiac deaths in the CABG Patch Trial and the Multicenter Automatic Defibrillator Implantation Trial (MADIT). The 198 deaths in the trial were reviewed by an independent Events Committee and classified by the method of Hinkle and Thaler. Only 54 deaths (27%) occurred out of hospital; 145 deaths (73%) were witnessed. Seventy-nine (82%) of the 96 deaths in the control group and 76 (75%) of the 102 deaths in the ICD group were due to cardiac causes. Cumulative arrhythmic mortality at 42 months was 6.9% in the control group and 4.0% in the ICD group (P=0. 057). Cumulative nonarrhythmic cardiac mortality at 42 months was 12. 4% in the control group and 13.0% in the ICD group (P=0.275). Death due to pump failure was significantly associated with death >1 hour from the onset of symptoms, dyspnea within 7 days of death, and overt heart failure within 7 days of death. In the CABG Patch Trial, ICD therapy reduced arrhythmic death 45% without significant effect on nonarrhythmic deaths. Because 71% of the deaths were nonarrhythmic, total mortality was not significantly reduced.