Key result
Implantable cardioverter-defibrillator therapy provides a significant survival benefit in primary and secondary prevention of sudden cardiac death, yielding an absolute risk reduction of 8 to 20% after four years.
Why the study?
Does implantable cardioverter-defibrillator (ICD) therapy reduce mortality in patients with coronary artery disease and dilated cardiomyopathy?
Does implantable cardioverter-defibrillator (ICD) therapy reduce mortality in patients with coronary artery disease and dilated cardiomyopathy?
ICD therapy provides significant survival benefits in primary and secondary prevention of sudden cardiac death, but careful risk stratification is crucial to balance benefits against competing risks and device-related complications.
Supports ICD use in CAD/DCM with quantified benefit; leaves open refined risk stratification to balance complications.
Contemporary guidelines refer to ICD implantation in patients who experienced ventricular tachycardia or fibrillation as secondary prevention, and in well-defined high risk groups as primary prevention. Randomised studies were performed in patients with coronary artery disease and in non-ischaemic cardiopathies, chiefly dilated cardiomyopathy. After four years' follow-up the absolute risk reduction was some 10% in secondary prevention and 8-20% in primary prevention, depending on the patient population. As only approx. 50% of ICD patients will receive appropriate therapies during long-term follow-up, reasonable risk stratification is crucial. However, apart from ejection fraction of <35%, all other echo- or electrocardiographic factors studied have thus far failed to have significant impact to determine risk in advance. In a retrospective analysis comorbidities such as advanced age, renal failure and atrial fibrillation have been shown to influence the effect of an ICD. During long term follow-up inappropriate shocks, lead complications, premature battery depletion and anxiety are some of the most significant problems for an ICD patient.
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Schaer et al. (2009) conducted a review in Coronary artery disease and dilated cardiomyopathy. Implantable cardioverter-defibrillator (ICD) vs. Medical therapy was evaluated on All-cause mortality and sudden cardiac death. Implantable cardioverter-defibrillator therapy provides a significant survival benefit in primary and secondary prevention of sudden cardiac death, yielding an absolute risk reduction of 8 to 20% after four years.
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