Key result
ICD or CRT-D implantation reduced 3-year all-cause mortality versus no device in non-ischemic (HR 0.51; 95% CI 0.38-0.68) and ischemic (HR 0.54; 95% CI 0.33-0.88) cardiomyopathy.
Why the study?
Implantable cardioverter-defibrillators are underutilized in primary prevention patients with ischemic and non-ischemic cardiomyopathy in Asia, Latin America, Eastern Europe, the Middle East, and Africa despite their potential benefit.
Does ICD or CRT-D implantation reduce all-cause mortality in primary prevention patients with ischemic or non-ischemic cardiomyopathy?
Cohort (n=2,429)
Open-label
Yes
Does ICD or CRT-D implantation reduce all-cause mortality in primary prevention patients with ischemic or non-ischemic cardiomyopathy?
ICD/CRT-D implantation provides a significant mortality benefit for both ischemic and non-ischemic cardiomyopathy patients meeting primary prevention guidelines in underrepresented global 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.
No takes yet. Share an insight, caveat, or question.
Singh et al. (2023) conducted a cohort in Ischemic and non-ischemic cardiomyopathy (n=2,429). ICD or CRT-D implantation vs. No ICD/CRT-D was evaluated on All-cause mortality at 3 years (NICM patients) (HR 0.51, 95% CI 0.38-0.68, p=<0.001). ICD or CRT-D implantation reduced 3-year all-cause mortality versus no device in non-ischemic (HR 0.51; 95% CI 0.38-0.68) and ischemic (HR 0.54; 95% CI 0.33-0.88) cardiomyopathy.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: