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176 J KARDIOL 2008; 15 (5–6)

ÖKG-Jahrestagung – Abstracts

long-term outcome. The aim of this study was either to investigate

mortality in patients with reduced LVEF (> 35 %) vs preserved

LVEF and, especially for patients with impaired LVEF, mortality

rates in ischemic cardiomyopathy (iCMP) vs non-ischemic cardio-

myopathy (non-iCMP).

Patients Between June 1988 and October 2006, 947 patients un-

derwent ICD implantation in our institution (82 % male; age at im-

plantation 58.9 ± 13.6 years), of which 34 were lost to clinical fol-

low-up after implantation (3.6 %). Data on LVEF and mortality

were available in 877 patients. In the collective with impaired LVEF

(438 patients), 333 suffered from iCMP (76 %) and 105 from non-

iCMP (24 %).

Results Within a follow-up period of 51 ± 44 months, overall

mortality was 31.8 % (290 patients, of which LVEF was not avail-

able in 11 patients). Mortality of patients with impaired LVEF was

186/438 (42.5 %), while it was 93/439 (21.2 %) in patients with pre-

served LVEF (p < 0.001). 5 and 8 year mortality rates were 38.2 %

and 53.6 % in patients with reduced LVEF compared to 17.6 % and

34.8 % in patients with preserved LVEF (p < 0.001), respectively.

In the collective with impaired LVEF, mortality among patients

with iCMP was 151/333 (45.3 %) while it was 35/105 (33 %) in

patients with non-iCMP. Five and 8 year mortality rates were

40.9 % and 54.1 % in patients with iCMP whereas subjects with

non-iCMP showed mortality rates of 27.6 % and 52 % (p = 0.104),

respectively.

Conclusion Although there were highly significant differences in

long-term mortality between patients with impaired and preserved

LVEF, mortality rates between patients with iCMP and non-iCMP

did not differ significantly.

Influence of Left Ventricular Impairment on Shock

Occurrence in Patients with ICDs 082

J. Siebermair, C. Schukro, G. Stix, T. Pezawas, J. Kastner, M. Wolzt, H. Schmidinger

Division of Cardiology, Department of Internal Medicine II, Medical University of

Vienna

Background The implantable cardioverter-defibrillator is effec-

tive in improving survival in high risk cardiac patients. The degree

of left ventricular ejection fraction (LVEF) is an important prognos-

tic marker of long-term survival. The purpose of this study was to

determine the influence of heart failure, as reflected by LVEF, on

shock occurrence in a large cohort of ICD recipients.

Methods Between June 1988 and October 2006, 947 patients

underwent ICD implantation in our institution (82 % male, age at

implantation 58.9 ± 13.6 years, CAD 65.6 %, dilated CMP 21.4 %,

others 13 %). Data on LVEF and shock delivery were available in

849 patients (89.7 %).

Results Within a follow-up period of 51 ± 44 months, 34.4 %

of our patients received at least one appropriate shock. At the end

of follow-up, 61.5 % of patients with impaired LVEF and 69.6 %

of patients with preserved LVEF were free of appropriate shocks,

respectively. The 1- and 3-year incidence of appropriate shocks

was 18 %/33.1 % in patients with impaired LVEF, compared

to 14.7 %/26.1 % in patients with preserved LVEF, respectively

(p = 0.02). One-hundred and ninety-four of 849 patients (22.9 %)

received inappropriate shocks. The 1- and 3-year incidence of inap-

propriate shocks was 10.5 %/22.5 % in patients with impaired

LVEF, compared to 10.1 %/20.5 % in patients with preserved

LVEF, respectively. The mean time to the first inappropriate shock

averaged 26.2 ± 2.9 months in patients with impaired LVEF

compared to 28.3 ± 3.6 months in patients with preserved LVEF

(p = n. s.).

Conclusion Our study found a high incidence of appropriate and

inappropriate shocks, respectively. Although we could demonstrate

significantly decreased time to the first appropriate shock in pa-

tients with impaired left ventricular function, impaired pump func-

tion seems to have no influence on the incidence of inappropriate

shocks.

Shock Occurrence in ICD Patients with Ischemic and

Non-Ischemic Cardiomyopathy 083

J. Siebermair, C. Schukro, G. Stix, T. Pezawas, J Kastner, M. Wolzt, H. Schmidinger

Division of Cardiology, Department of Internal Medicine II, Medical University of

Vienna

Mortality benefit from implantable cardioverter-defibrillator therapy

in ischemic (ICM) and non-ischemic dilated cardiomyopathy

(NICM) is well defined. The aim of this study was to determine the

actuarial incidence of appropriate and inappropriate shocks in these

two groups of patients.

Methods Between June 1988 and October 2006, 743 patients with

ischemic or non-ischemic cardiomyopathy underwent ICD implan-

tation in our institution (82 % male; age at implantation 58.9 ± 13.6

years). Patients were eligible for our study when LVEF was less

than 35 percent.

Results From 418 patients (56.2 %) with impaired LVEF, 321

patients (78 %) had coronary artery disease (CAD), the remaining

97 patients (22 %) had dilated cardiomyopathy. At the end of fol-

low-up, 64.5 % of patients with ICM compared to 48.5 % with

NICM were free of appropriate shocks. The 1- and 3-year incidence

of appropriate shocks was 14.7 %/29.5 % in patients with ischemic

CMP and 30.7 %/43.6 % in patients with non-ischemic cardiomyo-

pathy, respectively. In patients with appropriate shocks, the mean

period to the first appropriate shock averaged 31.5 ± 3.0 months in

patients with ICM and 22.2 ± 3.7 months in patients with NICM

(p < 0.001).

21.8 % of patients in the ICM group and 31.6 % of patients in the

NICM group received inappropriate shocks. 1- and 3-year incidence

of inappropriate shocks was 7.6 %/19.9 % in patients with ischemic

CMP and 19.3 %/31 % in patients with non-ischemic CMP, respec-

tively (p = 0.12).

Conclusion We found a high incidence of appropriate and inap-

propriate shocks. Patients with NICM received appropriate and in-

appropriate ICD discharges earlier and at a greater rate than patients

with ICM.

Timing of Blood Sampling Determines the Platelet

Reactivity in Patients Undergoing Percutaneous

Coronary Intervention 018

J. M. Siller-Matula, K. Haber, S. Panzer, I. Lang, B. Jilma

Medical University of Vienna

Background Non-responsiveness to anti-platelet therapy is asso-

ciated with increased platelet reactivity, which corresponds to an in-

creased risk of major adverse coronary events (MACE).

Objectives To investigate the variability of platelet reactivity in

patients undergoing percutaneous coronary intervention (PCI) with

four different test assays at two different time points.

Methods Platelet function was assessed by the Vasodilator

Stimulated Phosphoprotein (VASP) phosphorylation assay, Imped-

ance Aggregometry (Multiplate Analyzer), Platelet Function Ana-

lyzer (PFA-100

) and Cone and Platelet Analyzer (CPA, Impact

Measurements were performed during percutaneous coronary inter-

vention (PCI, after implantation of the first stent and after 250 mg of

injectable acetyl-salicylic acid had been given intravenously) and

1 day thereafter (20–24 h) in 17 patients, who had been pre-treated

with Clopidogrel and aspirin.

Results Inhibition of platelet function by Clopidogrel and aspirin

was less during PCI than one day after PCI as measured with the

VASP assay and the aggregometry: the platelet reactivity index

(PRI, VASP assay), the adenosine diphosphate/prostaglandin (ADP

+ PG) and the arachidonic acid (AA) induced platelet aggregation

were 36 % (p = 0.035), 140 % (p = 0.047) and 70 % (p = 0.025)

higher during PCI than one day after PCI, respectively. Both tests

showed a higher prevalence of high post-treatment platelet reactiv-

ity (HPPR) during PCI than 1 day thereafter: VASP assay 41 % vs

0 % (p = 0.002), aggregometry: 76 % vs 29 % (p = 0.016). The col-

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