Implantable cardioverter-defibrillators for primary prevention in patients with ischemic or nonischemic cardiomyopathy

A systematic review and meta-analysis

Michalina Kołodziejczak, Felicita Andreotti, Mariusz Kowalewski, Antonino Buffon, Marco Matteo Ciccone, Gianfranco Parati, Pietro Scicchitano, Julia M. Umińska, Stefano De Servi, Kevin P. Bliden, Jacek Kubica, Alessandro Bortone, Filippo Crea, Paul Gurbel, Eliano P. Navarese

Research output: Contribution to journalReview article

23 Citations (Scopus)

Abstract

Background: Implantable cardioverter-defibrillators (ICDs) have a role in preventing cardiac arrest in patients at risk for life-threatening ventricular arrhythmias. Purpose: To compare ICD therapy with conventional care for the primary prevention of death of various causes in adults with ischemic or nonischemic cardiomyopathy. Data Sources: MEDLINE, Cochrane Central Register of Controlled Trials, Google Scholar, and EMBASE databases, as well as several Web sites, from 1 April 1976 through 31 March 2017. Study Selection: Randomized controlled trials, published in any language, comparing ICD therapy with conventional care and reporting mortality outcomes (all-cause, sudden, any cardiac, or noncardiac) in the primary prevention setting. Data Extraction: 2 independent investigators extracted study data and assessed risk of bias. Data Synthesis: Included were 11 trials involving 8716 patients: 4 (1781 patients) addressed nonischemic cardiomyopathy, 6 (4414 patients) ischemic cardiomyopathy, and 1 (2521 patients) both types of cardiomyopathy. Mean follow-up was 3.2 years. An overall reduction in all-cause mortality, from 28.26% with conventional care to 21.37% with ICD therapy (hazard ratio [HR], 0.81 [95% CI, 0.70 to 0.94]; P = 0.043), was found. The magnitude of reduction was similar in the cohorts with nonischemic (HR, 0.81 [CI, 0.72 to 0.91]) and ischemic (HR, 0.82 [CI, 0.63 to 1.06]) disease, although the latter estimate did not reach statistical significance. The rate of sudden death fell from 12.15% with conventional care to 4.39% with ICD therapy (HR, 0.41 [CI, 0.30 to 0.56]), with a similar magnitude of reduction in patients with ischemic (HR, 0.39 [CI, 0.23 to 0.68]) and those with nonischemic disease (HR, 0.44 [CI, 0.17 to 1.12]). Noncardiac and any cardiac deaths did not differ significantly by treatment. Limitation: Heterogeneous timing of ICD placement; heterogeneous pharmacologic and resynchronization co-interventions; trials conducted in different eras; adverse events and complications not reviewed. Conclusion: Overall, primary prevention with ICD therapy versus conventional care reduced the incidence of sudden and allcause death.

Original languageEnglish
Pages (from-to)103-111
Number of pages9
JournalAnnals of Internal Medicine
Volume167
Issue number2
DOIs
Publication statusPublished - Jul 18 2017

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Implantable Defibrillators
Primary Prevention
Cardiomyopathies
Meta-Analysis
Sudden Death
Therapeutics
Mortality
Information Storage and Retrieval
Heart Arrest
MEDLINE
Cardiac Arrhythmias
Cause of Death
Language
Randomized Controlled Trials
Research Personnel
Databases
Incidence

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Implantable cardioverter-defibrillators for primary prevention in patients with ischemic or nonischemic cardiomyopathy : A systematic review and meta-analysis. / Kołodziejczak, Michalina; Andreotti, Felicita; Kowalewski, Mariusz; Buffon, Antonino; Ciccone, Marco Matteo; Parati, Gianfranco; Scicchitano, Pietro; Umińska, Julia M.; De Servi, Stefano; Bliden, Kevin P.; Kubica, Jacek; Bortone, Alessandro; Crea, Filippo; Gurbel, Paul; Navarese, Eliano P.

In: Annals of Internal Medicine, Vol. 167, No. 2, 18.07.2017, p. 103-111.

Research output: Contribution to journalReview article

Kołodziejczak, M, Andreotti, F, Kowalewski, M, Buffon, A, Ciccone, MM, Parati, G, Scicchitano, P, Umińska, JM, De Servi, S, Bliden, KP, Kubica, J, Bortone, A, Crea, F, Gurbel, P & Navarese, EP 2017, 'Implantable cardioverter-defibrillators for primary prevention in patients with ischemic or nonischemic cardiomyopathy: A systematic review and meta-analysis', Annals of Internal Medicine, vol. 167, no. 2, pp. 103-111. https://doi.org/10.7326/M17-0120
Kołodziejczak, Michalina ; Andreotti, Felicita ; Kowalewski, Mariusz ; Buffon, Antonino ; Ciccone, Marco Matteo ; Parati, Gianfranco ; Scicchitano, Pietro ; Umińska, Julia M. ; De Servi, Stefano ; Bliden, Kevin P. ; Kubica, Jacek ; Bortone, Alessandro ; Crea, Filippo ; Gurbel, Paul ; Navarese, Eliano P. / Implantable cardioverter-defibrillators for primary prevention in patients with ischemic or nonischemic cardiomyopathy : A systematic review and meta-analysis. In: Annals of Internal Medicine. 2017 ; Vol. 167, No. 2. pp. 103-111.
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abstract = "Background: Implantable cardioverter-defibrillators (ICDs) have a role in preventing cardiac arrest in patients at risk for life-threatening ventricular arrhythmias. Purpose: To compare ICD therapy with conventional care for the primary prevention of death of various causes in adults with ischemic or nonischemic cardiomyopathy. Data Sources: MEDLINE, Cochrane Central Register of Controlled Trials, Google Scholar, and EMBASE databases, as well as several Web sites, from 1 April 1976 through 31 March 2017. Study Selection: Randomized controlled trials, published in any language, comparing ICD therapy with conventional care and reporting mortality outcomes (all-cause, sudden, any cardiac, or noncardiac) in the primary prevention setting. Data Extraction: 2 independent investigators extracted study data and assessed risk of bias. Data Synthesis: Included were 11 trials involving 8716 patients: 4 (1781 patients) addressed nonischemic cardiomyopathy, 6 (4414 patients) ischemic cardiomyopathy, and 1 (2521 patients) both types of cardiomyopathy. Mean follow-up was 3.2 years. An overall reduction in all-cause mortality, from 28.26{\%} with conventional care to 21.37{\%} with ICD therapy (hazard ratio [HR], 0.81 [95{\%} CI, 0.70 to 0.94]; P = 0.043), was found. The magnitude of reduction was similar in the cohorts with nonischemic (HR, 0.81 [CI, 0.72 to 0.91]) and ischemic (HR, 0.82 [CI, 0.63 to 1.06]) disease, although the latter estimate did not reach statistical significance. The rate of sudden death fell from 12.15{\%} with conventional care to 4.39{\%} with ICD therapy (HR, 0.41 [CI, 0.30 to 0.56]), with a similar magnitude of reduction in patients with ischemic (HR, 0.39 [CI, 0.23 to 0.68]) and those with nonischemic disease (HR, 0.44 [CI, 0.17 to 1.12]). Noncardiac and any cardiac deaths did not differ significantly by treatment. Limitation: Heterogeneous timing of ICD placement; heterogeneous pharmacologic and resynchronization co-interventions; trials conducted in different eras; adverse events and complications not reviewed. Conclusion: Overall, primary prevention with ICD therapy versus conventional care reduced the incidence of sudden and allcause death.",
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T1 - Implantable cardioverter-defibrillators for primary prevention in patients with ischemic or nonischemic cardiomyopathy

T2 - A systematic review and meta-analysis

AU - Kołodziejczak, Michalina

AU - Andreotti, Felicita

AU - Kowalewski, Mariusz

AU - Buffon, Antonino

AU - Ciccone, Marco Matteo

AU - Parati, Gianfranco

AU - Scicchitano, Pietro

AU - Umińska, Julia M.

AU - De Servi, Stefano

AU - Bliden, Kevin P.

AU - Kubica, Jacek

AU - Bortone, Alessandro

AU - Crea, Filippo

AU - Gurbel, Paul

AU - Navarese, Eliano P.

PY - 2017/7/18

Y1 - 2017/7/18

N2 - Background: Implantable cardioverter-defibrillators (ICDs) have a role in preventing cardiac arrest in patients at risk for life-threatening ventricular arrhythmias. Purpose: To compare ICD therapy with conventional care for the primary prevention of death of various causes in adults with ischemic or nonischemic cardiomyopathy. Data Sources: MEDLINE, Cochrane Central Register of Controlled Trials, Google Scholar, and EMBASE databases, as well as several Web sites, from 1 April 1976 through 31 March 2017. Study Selection: Randomized controlled trials, published in any language, comparing ICD therapy with conventional care and reporting mortality outcomes (all-cause, sudden, any cardiac, or noncardiac) in the primary prevention setting. Data Extraction: 2 independent investigators extracted study data and assessed risk of bias. Data Synthesis: Included were 11 trials involving 8716 patients: 4 (1781 patients) addressed nonischemic cardiomyopathy, 6 (4414 patients) ischemic cardiomyopathy, and 1 (2521 patients) both types of cardiomyopathy. Mean follow-up was 3.2 years. An overall reduction in all-cause mortality, from 28.26% with conventional care to 21.37% with ICD therapy (hazard ratio [HR], 0.81 [95% CI, 0.70 to 0.94]; P = 0.043), was found. The magnitude of reduction was similar in the cohorts with nonischemic (HR, 0.81 [CI, 0.72 to 0.91]) and ischemic (HR, 0.82 [CI, 0.63 to 1.06]) disease, although the latter estimate did not reach statistical significance. The rate of sudden death fell from 12.15% with conventional care to 4.39% with ICD therapy (HR, 0.41 [CI, 0.30 to 0.56]), with a similar magnitude of reduction in patients with ischemic (HR, 0.39 [CI, 0.23 to 0.68]) and those with nonischemic disease (HR, 0.44 [CI, 0.17 to 1.12]). Noncardiac and any cardiac deaths did not differ significantly by treatment. Limitation: Heterogeneous timing of ICD placement; heterogeneous pharmacologic and resynchronization co-interventions; trials conducted in different eras; adverse events and complications not reviewed. Conclusion: Overall, primary prevention with ICD therapy versus conventional care reduced the incidence of sudden and allcause death.

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