Key result
MADIT-ICD score fails to predict ventricular arrhythmias in primary prevention S-ICD patients overall.
Why the study?
To evaluate the usefulness of the newly proposed MADIT-ICD benefit score in a single-center register of S-ICD patients with various underlying cardiomyopathies receiving primary prevention.
Does the MADIT-ICD benefit score predict ventricular arrhythmias and non-arrhythmic death in a mixed cohort of primary prevention S-ICD patients?
Cohort (n=173)
No
Does the MADIT-ICD benefit score predict ventricular arrhythmias and non-arrhythmic death in a mixed cohort of primary prevention S-ICD patients?
The MADIT-ICD benefit score's ability to predict ventricular arrhythmias in a primary prevention S-ICD cohort was limited to patients with ischemic cardiomyopathy, suggesting it may overestimate arrhythmic risk in younger, non-ischemic populations.
Does not support routine use of the MADIT-ICD score in mixed primary prevention S-ICD cohorts; leaves open its value in ischemic cardiomyopathy and requires prospective validation.
Background: Decision-making in primary prevention is not always trivial and many clinical scenarios are not reflected in current guidelines. To help evaluate a patient’s individual risk, a new score to predict the benefit of an implantable defibrillator (ICD) for primary prevention, the MADIT-ICD benefit score, has recently been proposed. The score tries to predict occurrence of ventricular arrhythmias and non-arrhythmic death based on data from four previous MADIT trials. We aimed at examining its usefulness in a large single-center register of S-ICD patients with various underlying cardiomyopathies. Methods and results: All S-ICD patients with a primary preventive indication for ICD implantation from our large single-center database were included in the analysis (n = 173). During a follow-up of 1227 ± 978 days, 27 patients developed sustained ventricular arrhythmias, while 6 patients died for non-arrhythmic reasons. There was a significant correlation for patients with ischemic cardiomyopathy (ICM) (n = 29, p = 0.04) to the occurrence of ventricular arrhythmia. However, the occurrence of ventricular arrhythmias could not sufficiently be predicted by the MADIT-ICD VT/VF score (p = 0.3) in patients with (n = 142, p = 0.19) as well as patients without structural heart disease (n = 31, p = 0.88) and patients with LV-EF < 35%. Of the risk factors included in the risk score calculation, only non-sustained ventricular tachycardias were significantly associated with sustained ventricular arrhythmias (p = 0.02). Of note, non-arrhythmic death could effectively be predicted by the proposed non-arrhythmic mortality score as part of the benefit score (p = 0.001, r = 0.3) also mainly driven by ICM patients. Age, diabetes mellitus, and a BMI < 23 kg/m2 were key predictors of non-arrhythmic death implemented in the score. Conclusion: The MADIT-ICD benefit score adds a new option to evaluate expected benefit of ICD implantation for primary prevention. In a large S-ICD cohort of primary prevention, the value of the score was limited to patients with ischemic cardiomyopathy. Future research should evaluate the performance of the score in different subgroups and compare it to other risk scores to assess its value for daily clinical practice.
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Willy et al. (2022) conducted a cohort in Primary prevention of sudden cardiac death (n=173). MADIT-ICD benefit score was evaluated on Prediction of sustained ventricular arrhythmias (appropriate ICD therapy) by the MADIT-ICD VT/VF score (p=0.3). The MADIT-ICD VT/VF score did not significantly predict the occurrence of ventricular arrhythmias in a mixed cohort of primary prevention S-ICD patients (p=0.3), though it showed predictive value in the subgroup with ischemic cardiomyopathy (p=0.04).
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