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Review
. 2017 Jun 7;38(22):1738-1746.
doi: 10.1093/eurheartj/ehx028.

Implantable cardioverter defibrillators for primary prevention of death in left ventricular dysfunction with and without ischaemic heart disease: a meta-analysis of 8567 patients in the 11 trials

Matthew J Shun-Shin  1 , Sean L Zheng  1 , Graham D Cole  1 , James P Howard  1 , Zachary I Whinnett  1 , Darrel P Francis  1
Affiliations
Review

Implantable cardioverter defibrillators for primary prevention of death in left ventricular dysfunction with and without ischaemic heart disease: a meta-analysis of 8567 patients in the 11 trials

Matthew J Shun-Shin et al. Eur Heart J. .

Abstract

Aims: Primary prevention implantable cardioverter defibrillators (ICDs) are established therapy for reducing mortality in patients with left ventricular systolic dysfunction and ischaemic heart disease (IHD). However, their efficacy in patients without IHD has been controversial. We undertook a meta-analysis of the totality of the evidence.

Methods and results: We systematically identified all RCTs comparing ICD vs. no ICD in primary prevention. Eligible RCTs were those that recruited patients with left ventricular dysfunction, reported all-cause mortality, and presented their results stratified by the presence of IHD (or recruited only those with or without). Our primary endpoint was all-cause mortality. We identified 11 studies enrolling 8567 participants with left ventricular dysfunction, including 3128 patients without IHD and 5439 patients with IHD. In patients without IHD, ICD therapy reduced mortality by 24% (HR 0.76, 95% CI 0.64 to 0.90, P = 0.001). In patients with IHD, ICD implantation (at a dedicated procedure), also reduced mortality by 24% (HR 0.76, 95% CI 0.60 to 0.96, P = 0.02).

Conclusions: Until now, it has never been explicitly stated that the patients without IHD in COMPANION showed significant survival benefit from adding ICD therapy (to a background of CRT). Even before DANISH, meta-analysis of patients without ischaemic heart disease already showed reduced mortality. DANISH is consistent with these data. With a significant 24% mortality reduction in both aetiologies, it may no longer be necessary to distinguish between them when deciding on primary prevention ICD implantation.

Keywords: Cardiomyopathy; Heart failure; Implantable cardiac defibrillators; Ischaemic heart disease; Meta-analysis; Non-ischaemic.

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Figures

Figure 1
Figure 1
Study flow chart.
Figure 2
Figure 2
Title: Left ventricular dysfunction without ischaemic heart disease: impact of primary prevention ICD on all-cause mortality.
Figure 3
Figure 3
(A) Title: Left ventricular dysfunction with ischaemic heart disease: impact of primary prevention ICD on all-cause mortality. (B). Title: Left ventricular dysfunction with ischaemic heart disease: impact of primary prevention ICD implanted during a dedicated procedure on all-cause mortality.
Figure 4
Figure 4
Left ventricular dysfunction with acute myocardial infarction: impact of primary prevention ICD on all-cause mortality.
See this image and copyright information in PMC

Comment in

References

    1. Betts TR, Sadarmin PP, Tomlinson DR, Rajappan K, Wong KCK, Bono JP. D, Bashir Y.. Absolute risk reduction in total mortality with implantable cardioverter defibrillators: analysis of primary and secondary prevention trial data to aid risk/benefit analysis. Europace 2013;15:813–819. - PubMed
    1. Kusumoto FM, Calkins H, Boehmer J, Buxton AE, Chung MK, Gold MR, Hohnloser SH, Indik J, Lee R, Mehra MR, Menon V, Page RL, Shen W-K, Slotwiner DJ, Stevenson LW, Varosy PD, Welikovitch L.. HRS/ACC/AHA expert consensus statement on the use of implantable cardioverter-defibrillator therapy in patients who are not included or not well represented in clinical trials. Circulation 2014;130:94–125. - PubMed
    1. McMurray JJV. The ICD in heart failure–time for a rethink? N Engl J Med 2016;375:1283–1284. - PubMed
    1. Plot Digitizer [Internet]. Available from: http://plotdigitizer.sourceforge.net/. (24 January 2017).
    1. Guyot P, Ades AE, Ouwens MJNM, Welton NJ.. Enhanced secondary analysis of survival data: reconstructing the data from published Kaplan-Meier survival curves. BMC Med Res Methodol 2012;12:9. - PMC - PubMed

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