Article ID | Journal | Published Year | Pages | File Type |
---|---|---|---|---|
8651500 | The American Journal of Cardiology | 2018 | 6 Pages |
Abstract
The ACC/AHA/HRS (American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society) guidelines recommend implantable cardioverter-defibrillator (ICD) therapy primary prevention in all patients with severely reduced left ventricular ejection fraction (â¤30%) regardless of New York Heart Association (NYHA) functional class, whereas recent European guidelines limit the indication to those with symptomatic heart failure (NYHAââ¥âII). We therefore aimed to evaluate the long-term survival benefit of primary ICD therapy among postmyocardial infarction patients with and without heart failure (HF) symptoms who were enrolled in MADIT-II (Multicenter Automatic Defibrillator Implantation Trial II). We classified 1,164 MADIT-II patient groups according to the baseline NYHA class (NYHA I [nâ=â442], NYHA II [nâ=â425], and NYHA III [nâ=â297]); patients with NYHA IV were excluded. Multivariate Cox proportional hazards regression modeling was performed to compare the mortality reduction with ICD versus non-ICD therapy during 8 years of follow-up between the 3 NYHA groups. The median (interquartile range) follow-up time was 7.6 (3.5 to 9) years. At 8 years of follow-up, the cumulative probability of mortality in the non-ICD treatment arm was 57% for NYHA I, 57% for NYHA II, and 76% for NYHA III (pâ<0.001). Multivariate models demonstrated similar long-term mortality risk reduction with ICD compared with the non-ICD treatment arm regardless of HF symptoms: NYHA I (HRâ=â0.63, 0.46 to 0.85, pâ=â0.003), NYHA II (HRâ=â0.68, 0.50 to 0.93, pâ=â0.017), and NYHA III (HRâ=â0.68, 0.50 to 0.94, pâ=â0.018); p for NYHA class by treatment arm interaction >0.10. In conclusion, primary ICD therapy provides consistent long-term survival benefit among patients with previous myocardial infarction and severe left ventricular dysfunction, regardless of HF symptoms.
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Authors
Yitschak MD, Spencer MD, Arthur MD, Wojciech MD, PhD, Valentina MD, PhD, Jayson MD, Alon MD, Scott MS, Bronislava MS, Ilan MD,