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

• 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
• DOI: 10.1111/jce.13192
• EISSN: 1540-8167
• ISSN: 1045-3873

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.