ICD implantation for primary prevention was associated with similar long-term all-cause mortality compared to secondary prevention (HR 0.99; 95% CI 0.55-1.77; P=0.97).
Cohort (n=360)
Does ICD implantation for secondary prevention compared to primary prevention affect all-cause mortality and time to first appropriate ICD therapy in ICD recipients?
Patients receiving ICDs for secondary prevention experience earlier appropriate therapies than those treated for primary prevention, but long-term mortality remains similarly low in both groups.
Hazard Ratio: 0.99 (95% CI 0.55–1.77)
valor p: p=0.97
BACKGROUND: Implantable cardioverter-defibrillators (ICD) implanted after an episode of ventricular tachyarrhythmia (VTA) or in patients at high risk of VTA lower the long-term mortality. Comparisons of the clinical outcomes of the two indications are scarce. METHODS: The study enrolled 360 consecutive ICD recipients. The device was implanted for secondary prevention in 150 patients, whose mean age was 60 +/- 14 years, and mean left ventricular ejection fraction (LVEF) was 40 +/- 16%, and for primary prevention in 210 patients, whose mean age was 61 +/- 11 years, and mean LVEF was 31 +/- 13%. All-cause mortality and time to first appropriate ICD therapy were measured. RESULTS: The two study groups were similar with respect to age and prevalence of coronary artery disease. Mean LVEF was higher in the secondary prevention group (P = 0.001). Cox regression analysis revealed a significantly shorter time to first appropriate ICD therapy in the secondary prevention group (HR = 0.51, 95% CI = 0.30 - 0.87, P = 0.01). Over a mean follow-up of 37 +/- 19 months, the all-cause mortality in the overall population was 12.7%, and was similar in both subgroups (HR = 0.99, 95% CI = 0.55-1.77, P = 0.97). CONCLUSIONS: The long-term mortality in this unselected population of ICD recipients was low. Patients treated for secondary prevention received earlier appropriate ICD therapy than patients treated for primary prevention. Long-term mortality was similar in both groups. The higher VT incidence of VTA was effectively treated by the ICD and was not associated with a higher mortality.
Stockburger et al. (Mon,) conducted a cohort in Sudden cardiac death (n=360). ICD for primary prevention vs. ICD for secondary prevention was evaluated on All-cause mortality (HR 0.99, 95% CI 0.55-1.77, p=0.97). ICD implantation for primary prevention was associated with similar long-term all-cause mortality compared to secondary prevention (HR 0.99; 95% CI 0.55-1.77; P=0.97).