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Meta-analysis: ICDs reduce all-cause mortality in patients with nonischemic cardiomyopathy
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The use of implantable cardioverter defibrillators for primary prevention in patients with nonischemic cardiomyopathy conferred a significant pooled clinical benefit on all-cause mortality, according to a meta-analysis.
The findings differ from those of the recently published DANISH study of ICDs in patients with systolic HF not due to CAD.
Harsh Golwala, MD, of Brigham and Women’s Heart and Vascular Institute, and colleagues explored various journal databases for all randomized controlled clinical trial data from their inception to Oct. 20, 2016.
They found six trials that evaluated the efficacy of ICD use for primary prevention in patients with nonischemic cardiomyopathy. In the six trials, 2,970 patients with nonischemic cardiomyopathy were included.
After analyzing the six trials, a pooled statistically significant 23% decrease in all-cause mortality risk was shown in favor of ICD therapy (HR = 0.77; 95% CI, 0.64-0.91). In a separate analysis of trials that evaluated ICD plus optimal medical therapy compared with optimal medical therapy alone, a 24% decrease in all-cause mortality was found with ICD use (HR = 0.76; 95% CI, 0.62-0.94). Trials that included patients with cardiac resynchronization therapy devices were not included in this separate analysis.
A trend was also found in favor of ICD use for reduced risk for all-cause mortality when looking at two trials that investigated ICD plus CRT plus optimal medical therapy compared with CRT plus optimal medical therapy alone; however, it was not statistically significant (HR = 0.7; 95% CI, 0.39-1.26).
“Newly diagnosed [nonischemic cardiomyopathy] is a heterogeneous group of HF patients, and prior studies demonstrate that despite [optimal medical therapy], a subset of these patients remains at risk of sudden cardiac death. Our updated meta-analysis combining all available [randomized controlled trials] including [DANISH] demonstrates that ICDs reduce all-cause mortality by 23% in patients with [nonischemic cardiomyopathy]. This incremental reduction of all-cause mortality with ICD is substantial and provides support to the existing [American College of Cardiology/American Heart Association] guidelines until we acquire additional data,” Golwala and colleagues wrote. – by Suzanne Reist
Disclosure: The researchers report no relevant financial disclosures.
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