Journal
EUROPEAN HEART JOURNAL
Volume 38, Issue 22, Pages 1738-U65Publisher
OXFORD UNIV PRESS
DOI: 10.1093/eurheartj/ehx028
Keywords
Implantable cardiac defibrillators; Meta-analysis; Ischaemic heart disease; Cardiomyopathy; Non-ischaemic; Heart failure
Categories
Funding
- British Heart Foundation [FS/14/27/30752, FS/12/12/29294, FS/13/44/30291, FS/10/038]
- British Heart Foundation [FS/14/25/30676, FS/10/38/28268, FS/12/12/29294, CS/15/3/31405, FS/15/53/31615, FS/14/27/30752, FS/13/44/30291] Funding Source: researchfish
- National Institute for Health Research [CL-2016-21-001] Funding Source: researchfish
Ask authors/readers for more resources
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.
Authors
I am an author on this paper
Click your name to claim this paper and add it to your profile.
Reviews
Recommended
No Data Available