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PCI Linked to Fewer Sudden Cardiac Deaths

Swiss study finds coronary intervention preserves heart function better than medical management

THURSDAY, July 16 (HealthDay News) -- Percutaneous coronary intervention (PCI) was superior to medical management in preserving heart function and preventing sudden cardiac death (SCD) in patients with silent ischemia after myocardial infarction, according to a study in the July 15 issue of the American Journal of Cardiology.

Andreas Wolfgang Schoenenberger, M.D., of the University of Bern Hospital in Switzerland, analyzed data on a group of 201 patients with silent ischemia after myocardial infarction from the Swiss Interventional Study on Silent Ischemia Type II (SWISSI II) who were randomized to receive medical management or PCI. The study end point was SCD, with multivariable regression used to identify associations between variables and SCD.

During a mean follow-up of 10.3 years, the study group had 12 SCDs for an average annual rate of 0.6 percent. The researchers found that a decline in left ventricular ejection fraction (LVEF) was the sole independent predictor of SCD (other than age). Further, the LVEF decline was greater in medically-managed patients than in those who had received PCI, and also greater in those who continued to have myocardial ischemia or had recurrent myocardial infarction, compared to patients without those events. Also, PCI was found to reduce residual myocardial ischemia and recurrent myocardial infarction compared to medical management.

"In conclusion, patients with silent ischemia after myocardial infarction are at a substantial risk of SCD. The prevention of residual myocardial ischemia and recurrent myocardial infarction using PCI resulted in better long-term LVEF and a reduced SCD incidence," the authors write.

SWISSI II was funded by Hoechst Pharma, Merck Pharma, and Pfizer.

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