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(Circulation. 2000;101:1660.)
© 2000 American Heart Association, Inc.
Clinical Investigation and Reports |
Identification of Patients Most Likely to Benefit From Implantable Cardioverter-Defibrillator Therapy
The Canadian Implantable Defibrillator Study
From the Cardiovascular Research Group (R.S.), University of Calgary, Calgary, Alberta; McMaster University (S.C., R.R., M. Gent), Hamilton, Ontario; University of Western Ontario (A.K.), London, Ontario; and Dalhousie University (M. Gardner), Halifax, Nova Scotia, Canada.
Correspondence to Dr R. Sheldon, Cardiovascular Research Group, University of Calgary, 3330 Hospital Dr NW, Calgary, Alberta, Canada. E-mail sheldon{at}ucalgary.ca
Background—Patients with resuscitated ventricular tachyarrhythmias (ventricular tachycardia/ventricular fibrillation) benefit from implantable cardioverter-defibrillators (ICDs) compared with medical therapy. We hypothesized that the patients who benefit most from an ICD are those at greatest risk of death.
Methods and Results—In the Canadian Implantable
Defibrillator Study (CIDS), 659 patients with resuscitated
ventricular tachyarrhythmias were randomly
assigned to receive an ICD or amiodarone and were then followed
for a mean of 3 years. There were 98 and 83 deaths in the
amiodarone and ICD groups, respectively. We used
multivariate Cox analysis to assess the impact
of baseline parameters on the mortality in the
amiodarone group. Reduced left ventricular ejection
fraction, advanced age, and poor NYHA status identified high-risk
patients (P=0.0001 to 0.0009). Quartiles of risk were
constructed, and the mortality reduction associated with ICD treatment
in each quartile was assessed. There was a significant interaction
between risk quartile and the ICD treatment effect
(P=0.011). In the highest risk quartile, there was a
50% relative risk reduction (95% CI 21% to 68%) of death in the ICD
group, whereas in the 3 lower quartiles, there was no benefit. Patients
who are most likely to benefit from an ICD can be identified with a
simple risk score (
2 of the following factors: age 70 years, left
ventricular ejection fraction 
35%, and NYHA class III or
IV). Thirteen of 15 deaths that were prevented by the ICD occurred in
patients with 2 risk factors.
Conclusions—In CIDS, patients at highest risk of death benefited most from ICD therapy. These can be identified easily on the basis of age, poor ventricular function, and poor functional status.
Key Words: arrhythmia • death, sudden • survival • trials • risk factors
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