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Published on: February 28, 2012
Predicted benefit of an implantable cardioverter-defibrillator: the MADIT-ICD benefit score
Arwa Younis1, Jeffrey J Goldberger2, Valentina Kutyifa1
1Division of Cardiology, Department of Medicine, Clinical Cardiovascular Research Center, University of Rochester Medical Center, 265 Crittenden Blvd CU 420653, NY 14642, USA.
Insights
This study developed a new score to predict implantable cardioverter-defibrillator (ICD) benefit by assessing risks of ventricular tachycardia/fibrillation versus non-arrhythmic death. This personalized approach helps identify patients most likely to benefit from ICDs.
Area of Science:
- Cardiology
- Medical Devices
- Predictive Analytics
Background:
- Prophylactic implantable cardioverter-defibrillator (ICD) benefit varies among patients.
- Risk stratification for ICD implantation requires differentiating between life-threatening ventricular tachycardia/fibrillation (VT/VF) and non-arrhythmic mortality.
- Existing models do not adequately integrate competing risks for personalized ICD benefit prediction.
Purpose of the Study:
- To develop and validate a predictive score for prophylactic ICD benefit.
- To integrate competing risks of VT/VF and non-arrhythmic mortality into a single score.
- To stratify patients into distinct benefit groups for personalized ICD decision-making.
Main Methods:
- Utilized data from 4531 patients in the MADIT trials.
- Employed Fine and Gray regression to model competing risks of VT/VF and non-arrhythmic mortality.
- Identified key predictors for each risk and combined them into the MADIT-ICD benefit score.
Main Results:
- Identified 8 predictors for VT/VF and 7 for non-arrhythmic mortality.
- Developed three MADIT-ICD benefit groups with distinct risk profiles.
- Demonstrated significant differences in VT/VF versus non-arrhythmic mortality risks across benefit groups (e.g., 20% vs. 7% at 3 years in the highest benefit group).
Conclusions:
- The novel MADIT-ICD benefit score provides personalized prediction of prophylactic ICD efficacy.
- The score effectively weighs the risk of VT/VF against non-arrhythmic mortality.
- Validated internally and externally, the score offers a stable tool for clinical decision support.
Aims:
The benefit of prophylactic implantable cardioverter-defibrillator (ICD) is not uniform due to differences in the risk of life-threatening ventricular tachycardia (VT)/ventricular fibrillation (VF) and non-arrhythmic mortality. We aimed to develop an ICD benefit prediction score that integrates the competing risks.
Methods And Results:
The study population comprised all 4531 patients enrolled in the MADIT trials. Best-subsets Fine and Gray regression analysis was used to develop prognostic models for VT (≥200 b.p.m.)/VF vs. non-arrhythmic mortality (defined as death without prior sustained VT/VF). Eight predictors of VT/VF (male, age < 75 years, prior non-sustained VT, heart rate > 75 b.p.m., systolic blood pressure < 140 mmHg, ejection fraction ≤ 25%, myocardial infarction, and atrialarrhythmia) and 7 predictors of non-arrhythmic mortality (age ≥ 75 years, diabetes mellitus, body mass index < 23 kg/m2, ejection fraction ≤ 25%, New York Heart Association ≥II, ICD vs. cardiac resynchronization therapy with defibrillator, and atrial arrhythmia) were identified. The two scores were combined to create three MADIT-ICD benefit groups. In the highest benefit group, the 3-year predicted risk of VT/VF was three-fold higher than the risk of non-arrhythmic mortality (20% vs. 7%, P < 0.001). In the intermediate benefit group, the difference in the corresponding predicted risks was attenuated (15% vs. 9%, P < 0.01). In the lowest benefit group, the 3-year predicted risk of VT/VF was similar to the risk of non-arrhythmic mortality (11% vs. 12%, P = 0.41). A personalized ICD benefit score was developed based on the distribution of the two competing risks scores in the study population (https://is.gd/madit). Internal and external validation confirmed model stability.
Conclusions:
We propose the novel MADIT-ICD benefit score that predicts the likelihood of prophylactic ICD benefit through personalized assessment of the risk of VT/VF weighed against the risk of non-arrhythmic mortality.
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