Key result
Ischaemic cardiomyopathy was associated with higher mortality than non-ischaemic cardiomyopathy in patients receiving an ICD for primary prevention (adjusted HR 1.31; 95% CI 1.06-1.61; P=0.01).
Why the study?
The magnitude of benefit related to ICD therapy for primary prevention of sudden cardiac death in non-ischaemic versus ischaemic cardiomyopathy has not been extensively evaluated in clinical practice.
Does the clinical benefit and mortality outcome of ICD therapy for primary prevention of sudden cardiac death differ between patients with non-ischaemic versus ischaemic cardiomyopathy?
Cohort (n=5,485)
Yes
Does the clinical benefit and mortality outcome of ICD therapy for primary prevention of sudden cardiac death differ between patients with non-ischaemic versus ischaemic cardiomyopathy?
Hazard Ratio: 1.31 (95% CI 1.06–1.61)
Absolute Event Rate: 52.3% vs 42.4%
p-value: p=0.01
In everyday practice, appropriate ICD therapies are similar between NICM and ICM patients, but ICM patients have higher all-cause mortality driven by non-cardiovascular causes, while NICM patients experience more inappropriate shocks.
Higher ICM mortality in primary-prevention ICD recipients warrants non-cardiac comorbidity attention; leaves open etiology-specific ICD benefit.
Aim: The magnitude of benefit related to implantable cardioverter defibrillator (ICD) therapy for primary prevention of sudden cardiac death (SCD) in non-ischaemic cardiomyopathy (NICM) and ischaemic cardiomyopathy (ICM) has not been evaluated extensively in clinical practice. Methods and results: Of the 5539 consecutive patients enrolled in the multicentre Défibrillateur Automatique Implantable-Prévention Primaire (DAI-PP) study (2002-12), 5485 patients (with information on underlying heart disease) were included in the present analysis: 2181 (39.8%) had NICM and 3304 (60.2%) had ICM. ICM patients were older (63.7 ±10.3 vs. 60.6 ± 12.2 years, P < 0.0001), with a higher ejection fraction [27% (25-30) vs. 25% (20-30), P < 0.0001], narrower QRS (37.3% vs. 21.4% with QRS <120, P < 0.0001), and higher prevalence of sinus rhythm (77.3% vs. 74.0%, P = 0.009). During a mean follow-up of 3.1 ± 2.2 years, 814 patients died, giving a mortality incidence of 48.6 per 1000 person-years [95% confidence interval (CI) 45.2-51.9], higher among ICM patients (52.3, 95% CI 47.8-56.7) than in NICM patients (42.4, 95% CI 37.3-47.6; P = 0.008) (adjusted hazard ratio 1.31, 95% CI 1.06-1.61, P = 0.01). The increase in mortality among ICM patients was mainly due to non-cardiovascular mortality (P = 0.0002), whereas incidences of cardiovascular mortality (including ICD-unresponsive SCD) were similar in the two groups. Incidences of appropriate ICD interventions (anti-tachycardia pacing, shocks) were similar, but inappropriate therapies were more frequent in NICM (7.94 vs. 5.96%; P = 0.005). Conclusion: NICM and ICM patients had a same rate of ICD therapy for primary prevention of SCD in everyday practice. But, ICM patients more often died of a non- cardiovascular cause of death. Clinical Trial Registration: NCT 01992458.
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Amara et al. (2017) conducted a cohort in Cardiomyopathy requiring ICD for primary prevention of sudden cardiac death (n=5,485). Ischaemic cardiomyopathy vs. Non-ischaemic cardiomyopathy was evaluated on Mortality incidence (adjusted HR 1.31, 95% CI 1.06-1.61, p=0.01). Ischaemic cardiomyopathy was associated with higher mortality than non-ischaemic cardiomyopathy in patients receiving an ICD for primary prevention (adjusted HR 1.31; 95% CI 1.06-1.61; P=0.01).
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