Mortality Effect of ICD in Primary Prevention of Nonischemic Cardiomyopathy: A Meta‐Analysis of Randomized Controlled Trials

ICD in Nonischemic Cardiomyopathy Introduction Implantation of an implantable cardioverter defibrillator (ICD) for primary prevention of sudden cardiac death (SCD) is controversial in view of the recent DANISH trial which suggested no benefit with ICD for primary prevention in patients with non‐isch...

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Bibliographic Details
Published in:	Journal of cardiovascular electrophysiology Vol. 28; no. 5; pp. 538 - 543
Main Authors:	LUNI, FARAZ KHAN, SINGH, HEMINDERMEET, KHAN, ABDUR R., MALIK, SONIA A., KHAWAJA, OWAIS, RIAZ, HARIS, LEE, WADE, KABOUR, AMEER, RICHARDS, MARK, AASBO, JOHAN
Format:	Journal Article
Language:	English
Published:	United States Wiley Subscription Services, Inc 01-05-2017
Subjects:	Adrenergic beta-Antagonists - therapeutic use Adult Aged Aldosterone Angiotensin Receptor Antagonists - therapeutic use Angiotensin-Converting Enzyme Inhibitors - therapeutic use Cardiac arrhythmia Cardiomyopathies - complications Cardiomyopathies - diagnosis Cardiomyopathies - mortality Cardiomyopathies - therapy Cardiomyopathy Chi-Square Distribution Clinical trials DANISH trial Death, Sudden, Cardiac - etiology Death, Sudden, Cardiac - prevention & control Defibrillators Defibrillators, Implantable Electric Countershock - adverse effects Electric Countershock - instrumentation Electric Countershock - mortality Heart diseases Humans implantable cardioverter defibrillator Ischemia Meta-analysis Middle Aged Mineralocorticoid Receptor Antagonists - therapeutic use Mortality nonischemic cardiomyopathy Odds Ratio Prevention Primary Prevention - instrumentation Randomized Controlled Trials as Topic Risk Factors Sensitivity analysis Statistical analysis sudden cardiac death Treatment Outcome meta-analysis DANISH trial implantable cardioverter defibrillator nonischemic cardiomyopathy sudden cardiac death
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Summary:	ICD in Nonischemic Cardiomyopathy Introduction Implantation of an implantable cardioverter defibrillator (ICD) for primary prevention of sudden cardiac death (SCD) is controversial in view of the recent DANISH trial which suggested no benefit with ICD for primary prevention in patients with non‐ischemic cardiomyopathy (NICMP). Methods We conducted a meta‐analysis of randomized control trials studying the role of ICD in primary prevention of SCD in patients with NICMP. Only six studies were identified after the application of inclusion/exclusion criteria. Results Pooling of these randomized trials showed a statistically significant benefit of using ICDs in patients with NICMP [OR 0.76 (0.64 – 0.91), I2 = 0%]. Sensitivity analysis did not show a statistically significant mortality benefit of ICD in NICMP in trials which had adequate beta blocker, ACE/ARB and aldosterone receptor blocker (ALD‐RB) use [OR 0.70 (0.41, 1.19), I2 = 70%]. Conclusion The DANISH trial's failure to show mortality benefit may be due to the significant number of patients who had CRT. Our meta‐analysis studied the independent effect of ICDs and showed them to be associated with net mortality benefits in patients who are not on optimal guideline directed medical therapy; especially the patients not on ALD‐RB.
Bibliography:	M. Richards is part owner of a biotech company developing a painless low‐voltage defibrillator. J. Aasbo reports compensation from Boston Scientific and Biotronik for participation on a speaker's bureau relevant to this topic. Other authors: No disclosures. ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Feature-1 content type line 23
ISSN:	1045-3873 1540-8167
DOI:	10.1111/jce.13192