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An implantable cardioverter-defibrillator for primary prevention in non-ischemic cardiomyopathy: A systematic review and meta-analysis
Affiliations- Faculty of Medical Science, Car dinal Wyszynski University in Warsaw, Poland
- 3rd Department of Cardiology, Silesian Center for Heart Diseases, Medical University of Silesia, Zabrze, Poland
- Department of Applied Physiology, Mossakowski Medical Research Center, Polish Academy of Sciences, Warsaw, Poland
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Abstract
Background: Recent data regarding the comparison of implantable cardioverter-defibrillator (ICD)
therapy and optimal medical treatment in patients with non-ischemic cardiomyopathy has indicated
no mortality benefit as a result of ICD therapy. Although the recommendations for ICD implantation
did not change, it is worth noting that these findings significantly affected the daily practice of ICD
implantation in Europe.
Methods: To assess the effect of ICD implantation in comparison to pharmacotherapy in the non-
-ischemic cardiomyopathy heart failure population through a systematic review and meta-analysis of the
available carefully designed prospective randomized controlled trials. Only prospective randomized controlled
trials comparing ICD implantation in primary prevention vs. optimal pharmacological therapy
or placebo and reporting mortality results were included in the meta-analysis. The authors have chosen
to include the following trials: CAT, AMIOVIRT, DEFINITE, and DANISH.
Results: A meta-analysis of pooled hazard ratios (HR) from all trials conducted on a total of 1789
patients found that ICD therapy decreased all-cause mortality in comparison to optimal pharmacological
treatment, with a HR of 0.48 (95% confidence interval [CI] 0.67–1.01); p = 0.06. The data from
the AMIOVIRT, DANISH, and DEFINITE trials, with a total of 1677 participants, showed a significant
reduction of sudden cardiac deaths as a result of ICD implantation, with a HR of 0.48 (95% CI
0.31–0.67); p < 0.001.
Conclusions: In comparison with optimal medical treatment, ICD implantation in patients with heart
failure improves the long-term prognosis in terms of sudden cardiac death, with a strong tendency towards
all-cause mortality reduction.
Abstract
Background: Recent data regarding the comparison of implantable cardioverter-defibrillator (ICD)
therapy and optimal medical treatment in patients with non-ischemic cardiomyopathy has indicated
no mortality benefit as a result of ICD therapy. Although the recommendations for ICD implantation
did not change, it is worth noting that these findings significantly affected the daily practice of ICD
implantation in Europe.
Methods: To assess the effect of ICD implantation in comparison to pharmacotherapy in the non-
-ischemic cardiomyopathy heart failure population through a systematic review and meta-analysis of the
available carefully designed prospective randomized controlled trials. Only prospective randomized controlled
trials comparing ICD implantation in primary prevention vs. optimal pharmacological therapy
or placebo and reporting mortality results were included in the meta-analysis. The authors have chosen
to include the following trials: CAT, AMIOVIRT, DEFINITE, and DANISH.
Results: A meta-analysis of pooled hazard ratios (HR) from all trials conducted on a total of 1789
patients found that ICD therapy decreased all-cause mortality in comparison to optimal pharmacological
treatment, with a HR of 0.48 (95% confidence interval [CI] 0.67–1.01); p = 0.06. The data from
the AMIOVIRT, DANISH, and DEFINITE trials, with a total of 1677 participants, showed a significant
reduction of sudden cardiac deaths as a result of ICD implantation, with a HR of 0.48 (95% CI
0.31–0.67); p < 0.001.
Conclusions: In comparison with optimal medical treatment, ICD implantation in patients with heart
failure improves the long-term prognosis in terms of sudden cardiac death, with a strong tendency towards
all-cause mortality reduction.
Keywords
implantable cardioverter-defibrillator, meta-analysis, non-ischemic cardiomyopathy, systematic review
About this articleTitle
An implantable cardioverter-defibrillator for primary prevention in non-ischemic cardiomyopathy: A systematic review and meta-analysis
Journal
Issue
Article type
Original Article
Pages
117-124
Published online
2021-04-09
Page views
4183
Article views/downloads
1039
DOI
Pubmed
Bibliographic record
Cardiol J 2023;30(1):117-124.
Keywords
implantable cardioverter-defibrillator
meta-analysis
non-ischemic cardiomyopathy
systematic review
Authors
Michał Wasiak
Mateusz Tajstra
Dariusz Kosior
Mariusz Gąsior
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