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Cardioverter-defibrillator reduces mortality risk in eligible ischemic and non-ischemic cardiomyopathy patients:
Balbir Singh1, Yu-Cheng Hsieh2, Yen-Bin Liu3
1Department of Cardiology, Pan Max Hospital, New Delhi, India.
Insights
Implantable cardioverter-defibrillators (ICDs) significantly reduce mortality in primary prevention patients with non-ischemic and ischemic cardiomyopathy. Device therapy rates were similar between both groups, highlighting the benefit of ICDs for sudden cardiac arrest prevention.
Area of Science:
- Cardiology
- Electrophysiology
- Public Health
Background:
- Sudden cardiac arrest (SCA) poses a significant global health burden.
- Implantable cardioverter-defibrillators (ICDs) are underutilized, especially in Asia, Latin America, Eastern Europe, the Middle East, and Africa.
- The Improve SCA trial previously showed benefit of ICDs/CRT-Ds in primary prevention (PP) patients in these regions.
Purpose of the Study:
- To compare device therapy rates and mortality in primary prevention patients with ischemic (ICM) and non-ischemic cardiomyopathy (NICM).
- To evaluate outcomes for patients meeting guideline indications for ICD therapy who received an ICD or CRT-D.
Main Methods:
- Prospective, non-randomized, non-blinded, multicenter trial (Improve SCA).
- Inclusion of PP patients from underrepresented regions meeting ICD implantation criteria.
- Analysis of all-cause mortality and device therapy by cardiomyopathy type (ICM vs. NICM) and implantation status using Cox proportional hazards models.
Main Results:
- 54.5% of NICM patients and 52.1% of ICM patients received an ICD/CRT-D.
- At 3 years, all-cause mortality was significantly lower in NICM patients with an ICD/CRT-D (13.1%) vs. without (18.3%; HR 0.51).
- Similarly, ICM patients with an ICD/CRT-D had lower 3-year mortality (13.8%) vs. without (19.9%; HR 0.54).
- Time to first device therapy, shock, or antitachycardia pacing (ATP) did not differ significantly between groups.
Conclusions:
- Defibrillator implantation significantly reduces mortality in both NICM and ICM patients with guideline-based primary prevention indications.
- Appropriate device therapy rates were comparable between NICM and ICM patient groups.
- The findings support ICD/CRT-D use in selected PP patients across diverse geographic regions.
Background & Objective:
Despite the burden of sudden cardiac arrest (SCA) worldwide, implantable cardioverter-defibrillators (ICDs) are underutilized, particularly in Asia, Latin America, Eastern Europe, the Middle East, and Africa. The Improve SCA trial demonstrated that primary prevention (PP) patients in these regions benefit from an ICD or a cardiac resynchronization therapy defibrillator (CRT-D). We aimed to compare the rate of device therapy and mortality among ischemic and non-ischemic cardiomyopathy (ICM and NICM) PP patients who met guideline indications for ICD therapy and had an ICD/CRT-D implanted.
Methods:
Improve SCA was a prospective, non-randomized, non-blinded multicenter trial that enrolled patients from the above-mentioned regions. All-cause mortality and device therapy were examined by cardiomyopathy (ICM vs NICM) and implantation status. Cox proportional hazards methods were used, adjusting for factors affecting mortality risk.
Results:
Of 1848 PP NICM patients, 1007 (54.5%) received ICD/CRT-D, while 303 of 581 (52.1%) PP ICM patients received an ICD/CRT-D. The all-cause mortality rate at 3 years for NICM patients with and without an ICD/CRT-D was 13.1% and 18.3%, respectively (HR 0.51, 95% CI 0.38-0.68, p < 0.001). Similarly, all-cause mortality at 3 years in ICM patients was 13.8% in those with a device and 19.9% in those without an ICD/CRT-D (HR 0.54, 95% CI 0.33-.0.88, p = 0.011). The time to first device therapy, time to first shock, and time to first antitachycardia pacing (ATP) therapy were not significantly different between groups (p ≥ 0.263).
Conclusions:
In this large data set of patients with a guideline-based PP ICD indication, defibrillator device implantation conferred a significant mortality benefit in both NICM and ICM patients. The rate of appropriate device therapy was also similar in both groups.
Clinical Trial Registration:
ClinicalTrials.gov ID: NCT02099721.
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