Abstract 12421: Mortality After Appropriate ICD Therapies: Implementation of the MADIT II Risk Score in Clinical Practice
Introduction: The benefit of ICD therapy is not uniform in patients with low ejection fraction. The MADIT II investigators identified various clinical factors that influenced survival benefit in their study population. The objective of this study was to test whether these factors influence mortality after appropriate ICD therapy, thereby influencing the potential benefit conferred by ICD therapy in current clinical practice.
Methods: For the current analysis all patients receiving their initial ICD / CRT-D between January 1996 and September 2009 were reviewed. All patients with a primary prevention indication who experienced appropriate ICD therapy were included. The influence of the clinical risk factors, derived from the MADIT II study (age >70 yrs, NYHA class > II, eGFR<60 ml/min, QRS > 120 ms, atrial fibrillation), on survival after appropriate ICD therapy was consequently assessed.
Results: A total of 296 patients (82% male, mean age 62.5±10.5) were included. During an average follow-up of 26 ± 23 months 55 (19%) patients died. The 5-year cumulative survival significantly declined from 90%±10% in patients with no risk factors to 46%±16% in patients with ≥3 risk factors. (Figure 1) Cox regression analysis demonstrated a 4.0-fold (HR 4.1, 95% CI: 1.6 - 10.6, p =0.004) increased risk for mortality in patients ≥3 risk factors compared to patients with no risk factors.
Conclusion: Previously established clinical risk factors are significantly predictive for mortality following appropriate ICD therapies thereby negatively influencing potential benefit conferred by prophylactic ICD implantation. These risk factors could be useful in optimizing patient selection for this treatment strategy.
- © 2011 by American Heart Association, Inc.