Predicted bene it of an implantable cardioverter-defibrillator: the MADIT-ICD benefit score

Aims The benefit of prophylactic implantable cardioverter-defibrillator (ICD) is not uniform due to differences in the risk of life-threatening ventricular tachycardia (VT)/ventricular fibrillation (VF) and non-arrhythmic mortality. We aimed to develop an ICD benefit prediction score that integrates the competing risks. Methods and results The study population comprised all 4531 patients enrolled in the MADIT trials. Best-subsets Fine and Gray regression analysis was used to develop prognostic models for VT (>= 200 b.p.m.)/VF vs. non-arrhythmic mortality (defined as death without prior sustained VT/VF). Eight predictors of VTNF (male, age < 75 years, prior non-sustained VT, heart rate > 75 b.p.m., systolic blood pressure < 140 mmHg, ejection fraction <= 25%, myocardial infarction, and atria[arrhythmia) and 7 predictors of non-arrhythmic mortality (age >= 75 years, diabetes mellitus, body mass index < 23 kg/m(2), ejection fraction <= 25%, New York Heart Association >= II, ICD vs. cardiac resynchronization therapy with defibrillator, and atrial arrhythmia) were identified. The two scores were combined to create three MADIT-ICD benefit groups. In the highest benefit group, the 3-year predicted risk of VT/VF was three-fold higher than the risk of non-arrhythmic mortality (20% vs. 7%, P < 0.001). In the intermediate benefit group, the difference in the corresponding predicted risks was attenuated (15% vs. 9%, P< 0.01). In the lowest benefit group, the 3-year predicted risk of VT/VF was similar to the risk of non-arrhythmic mortality (11% vs. 12%, P = 0.41). A personalized ICD benefit score was developed based on the distribution of the two competing risks scores in the study population (https://is.gd/madit) . Internal and external validation confirmed model stability. Conclusions We propose the novel MADIT-ICD benefit score that predicts the likelihood of prophylactic ICD benefit through personalized assessment of the risk of VT/VF weighed against the risk of non-arrhythmic mortality. [GRAPHICS] .

Automated summary

A personalized ICD benefit prediction score has been developed to assess the likelihood of prophylactic ICD benefit by integrating the risks of ventricular tachycardia/ventricular fibrillation and non-arrhythmic mortality. Three different benefit groups were identified, based on the predicted risks, providing a reference for decision-making on prophylactic ICD implantation.