Primary prevention ICD implantation post-2017 was associated with unchanged appropriate therapy rates in DCM (4.0 vs 3.1/100 PY, p=0.57) but lower rates in ICM (3.1 vs 6.2/100 PY, p=0.01).
Cohort (n=393)
Yes
Does the era of primary prevention ICD implantation (post-2017 vs pre-2017) affect the incidence of appropriate ICD therapy and mortality in patients with DCM and ICM?
Temporal trends show that while DCM patients receiving primary prevention ICDs post-2017 are younger with higher LVEF, their appropriate therapy rates remain unchanged, whereas ICM patients experience fewer appropriate therapies in the modern era.
Absolute Event Rate: 4% vs 3.1%
p-value: p=0.57
Abstract Background The effect of primary prevention ICD (ppICD) in non-ischemic dilated cardiomyopathy (DCM) remains debated. We investigated long-term outcomes and the incidence of ppICD therapy in patients with DCM and ischaemic cardiomyopathy (ICM), comparing implants before and after 2017. Methods We prospectively included ppICD patients from the multicenter IMPROVE study (2014-2022) with DCM and ICM. All underwent ECG and echocardiography at baseline. Primary outcome was appropriate ICD therapy; secondary outcome was all-cause mortality. Outcomes were compared pre- and post-2017 in DCM and ICM patients. Results Among 393 ppICD patients (median age 66, 15% female), 115 had DCM (66 post-2017, 49 pre-2017) and 278 had ICM (165 post-2017, 113 pre-2017). DCM post-2017 patients were younger (54 vs. 64 years, p 0.01) and had a higher left ventricular ejection fraction (LVEF) (33% vs. 24%, p0.001) compared to DCM pre-2017 patients. Nevertheless, ICD therapy (4.0 vs. 3.1/100 person-years (PY), p = 0.57) and all-cause mortality rates (2.0 vs. 4.7/100 PY, p = 0.09) were similar. ICM post-2017 patients had a slightly higher LVEF (31% vs. 29%, p = 0.04), fewer ICD therapies (3.1 vs. 6.2/100 PY, p = 0.01), and similar mortality rates (6.3 vs. 8.3/100 PY, p = 0.18) compared to pre-2017. Conclusions Patient selection for ppICD in DCM changed post-2017, with a shift towards younger patients and better LVEF compared to those implanted pre-2017; however, appropriate ICD therapy and all-cause mortality rates remained unchanged. In ICM, lower ICD therapy rates post-2017, may reflect improvement in revascularization and heart failure treatments. Trial Registration ClinicalTrials.gov Identifier: NCT02286908
Nguyen et al. (Tue,) conducted a cohort in Non-ischaemic dilated cardiomyopathy and ischaemic cardiomyopathy (n=393). Primary prevention ICD implantation post-2017 vs. Primary prevention ICD implantation pre-2017 was evaluated on appropriate ICD therapy (p=0.57). Primary prevention ICD implantation post-2017 was associated with unchanged appropriate therapy rates in DCM (4.0 vs 3.1/100 PY, p=0.57) but lower rates in ICM (3.1 vs 6.2/100 PY, p=0.01).