Abstract
Background
Primary prophylactic implantable cardioverter-defibrillators (ICDs) in patients with non-ischaemic cardiomyopathy (NICMP) remains controversial. This study sought to assess the benefit of ICD therapy with or without cardiac resynchronisation therapy (CRT) in patients with NICMP. In addition, data were compared with real-world clinical data to perform a risk/benefit analysis.
Methods
Relevant randomised clinical trials (RCTs) published in meta-analyses since DANISH, and in PubMed, EMBASE and Cochrane databases from 2016 to 2020 were identified. The benefit of ICD therapy stratified by CRT use was assessed using random effects meta-analysis techniques.
Results
Six RCTs were included in the meta-analysis. Among patients without CRT, ICD use was associated with a 24% reduction in mortality (hazard ratio [HR]: 0.76; 95% confidence interval [CI]: 0.62–0.93; P = 0.008). In contrast, among patients with CRT, a CRT-defibrillator was not associated with reduced mortality (HR: 0.74, 95% CI 0.47–1.16; P = 0.19). For ICD therapy without CRT, absolute risk reduction at 3‑years follow-up was 3.7% yielding a number needed to treat of 27.
Conclusion
ICD use significantly improved survival among patients with NICMP who are not eligible for CRT. Considering CRT, the addition of defibrillator therapy was not significantly associated with mortality benefit compared with CRT pacemaker.
Primary prophylactic implantable cardioverter-defibrillators (ICDs) in patients with non-ischaemic cardiomyopathy (NICMP) remains controversial. This study sought to assess the benefit of ICD therapy with or without cardiac resynchronisation therapy (CRT) in patients with NICMP. In addition, data were compared with real-world clinical data to perform a risk/benefit analysis.
Methods
Relevant randomised clinical trials (RCTs) published in meta-analyses since DANISH, and in PubMed, EMBASE and Cochrane databases from 2016 to 2020 were identified. The benefit of ICD therapy stratified by CRT use was assessed using random effects meta-analysis techniques.
Results
Six RCTs were included in the meta-analysis. Among patients without CRT, ICD use was associated with a 24% reduction in mortality (hazard ratio [HR]: 0.76; 95% confidence interval [CI]: 0.62–0.93; P = 0.008). In contrast, among patients with CRT, a CRT-defibrillator was not associated with reduced mortality (HR: 0.74, 95% CI 0.47–1.16; P = 0.19). For ICD therapy without CRT, absolute risk reduction at 3‑years follow-up was 3.7% yielding a number needed to treat of 27.
Conclusion
ICD use significantly improved survival among patients with NICMP who are not eligible for CRT. Considering CRT, the addition of defibrillator therapy was not significantly associated with mortality benefit compared with CRT pacemaker.
| Original language | English |
|---|---|
| Pages (from-to) | 89-99 |
| Number of pages | 11 |
| Journal | Netherlands Heart Journal |
| Volume | 31 |
| Issue number | 3 |
| Early online date | 6 Sept 2022 |
| DOIs | |
| Publication status | Published - Mar 2023 |
Bibliographical note
Funding Information:D.A. Theuns has received research grants from Biotronik and Boston Scientific, and consulting fees from Boston Scientific. P.P. Delnoy has received speaker and consulting fees from Abbott, Biotronik, Boston Scientific, Microport and Medtronic. C.P. Allaart has received institutional research grants from Abbott, Biotronik and Medtronic, and received speaker fees from Abbott and Biotronik. K. Vernooy is listed as consultant for Abbott, Medtronic and received speaker fees from Abbott, Medtronic and Microport. T.E. Verstraelen, A.C.J. van der Lingen, L. van Erven, A.H. Maass, A.A.M. Wilde, E. Boersma and J.G. Meeder declare that they have no competing interests.
Publisher Copyright:
© 2022, The Author(s).