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Clinical course and implantable cardioverter defibrillator therapy in postinfarction women with severe left

Wojciech Zareba1, Arthur J Moss, W Jackson Hall

  • 1Cardiology Unit, Department of Medicine, University of Rochester Medical Center, Rochester, New York 14642-8653, USA. wojciech_zareba@urmc.rochester.edu

Journal of Cardiovascular Electrophysiology
|January 13, 2006
PubMed

Insights

Women with severe left ventricular dysfunction after heart attack had similar mortality and implantable cardioverter defibrillator (ICD) effectiveness compared to men. ICDs in women reduced arrhythmic events and ventricular tachycardia episodes more than in men.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Medical Devices

Background:

  • Limited data exist on implantable cardioverter defibrillator (ICD) therapy in women with severe left ventricular dysfunction post-myocardial infarction.
  • The Multicenter Automatic Defibrillator Implantation Trial II (MADIT II) provides a cohort for evaluating sex-based differences in ICD outcomes.

Purpose of the Study:

  • To compare the risk of cardiac events and the effectiveness of ICD therapy between women and men in the MADIT II trial.
  • To analyze sex-specific outcomes in patients with severe left ventricular dysfunction after myocardial infarction.

Main Methods:

  • Analysis of 1,232 patients (192 women, 1,040 men) from the MADIT II trial.
  • Comparison of baseline characteristics, 2-year mortality, and ICD therapy effectiveness between genders.
  • Statistical adjustment for relevant clinical covariates.

Main Results:

  • Women had higher rates of NYHA class >II, hypertension, diabetes, and LBBB, but less frequent CABG surgery compared to men.
  • Two-year mortality was similar between women and men on conventional therapy (30% vs. 20%, P=0.19).
  • ICD effectiveness (hazard ratio) was similar in women (0.57) and men (0.66), with a lower risk of appropriate ICD therapy for VT/VF in women (HR=0.60, P=0.039).

Conclusions:

  • Women in MADIT II experienced similar mortality and ICD effectiveness compared to men.
  • ICD therapy in women was associated with a reduced risk of arrhythmic events and fewer episodes of ventricular tachycardia than in men.
Abstract

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