The mortality analysis of primary prevention patients receiving a cardiac resynchronization defibrillator (CRT-D) or implantable cardioverter-defibrillator (ICD) according to guideline indications in the improve SCA study

Ching CK 1 , Hsieh YC 2 , Liu YB 3 , Rodriguez DA 4 , Kim YH 5 , Joung B 6 Show all authors , Singh B 7 , Huang D 8 , Hussin A 9 , Chasnoits AR 10 , O'Brien JE 11 , Cerkvenik J 11 , Lexcen D 11 , Van Dorn B 11 , Zhang S 12

Affiliations 

  • 1 Department of Cardiology, National Heart Centre of Singapore, Outram, Singapore
  • 2 Division of Cardiology, Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
  • 3 Division of Cardiology, Internal Medicine Department, National Taiwan University Hospital, Taipei, Taiwan
  • 4 Fundación Cardioinfantil, Instituto de Cardiología Fundación Cardio infantil, Centro Internacional de Arritmias, Bogotá, Colombia
  • 5 Department of Cardiology, Korea University Anam Hospital, Seoul, Republic of Korea
  • 6 Department of Cardiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
  • 7 Department of Cardiology, Medanta, The Medicity Hospital, Gurgaon, Haryana, India
  • 8 Department of Cardiovascular Medicine, West China Hospital, Chengdu, China
  • 9 Department of Cardiology, Institut Jantung Negara, Kuala Lumpur, Malaysia
  • 10 Republican Scientific Practical Centre Cardiology, Minsk, Belarus
  • 11 Cardiac Rhythm Management, Medtronic plc, Mounds View, Minnesota, USA
  • 12 Fu Wai Hospital Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
J Cardiovasc Electrophysiol, 2021 08;32(8):2285-2294.
PMID: 34216069 DOI: 10.1111/jce.15149

Abstract

BACKGROUND: In primary prevention (PP) patients the utilization of implantable cardioverter-defibrillators (ICD) and cardiac resynchronization therapy-defibrillators (CRT-D) remains low in many geographies, despite the proven mortality benefit.

PURPOSE: The objective of this analysis was to examine the mortality benefit in PP patients by guideline-indicated device type: ICD and CRT-D.

METHODS: Improve sudden cardiac arrest was a prospective, nonrandomized, nonblinded multicenter trial that enrolled patients from regions where ICD utilization is low. PP patient's CRT-D or ICD eligibility was based upon the 2008 ACC/AHA/HRS and 2006 ESC guidelines. Mortality was assessed according to guideline-indicated device type comparing implanted and nonimplanted patients. Cox proportional hazards methods were used, adjusting for known factors affecting mortality risk.

RESULTS: Among 2618 PP patients followed for a mean of 20.8 ± 10.8 months, 1073 were indicated for a CRT-D, and 1545 were indicated for an ICD. PP CRT-D-indicated patients who received CRT-D therapy had a 58% risk reduction in mortality compared with those without implant (adjusted hazard ratio [HR]: 0.42, 95% confidence interval [CI]: 0.28-0.61, p 

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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