P394Which is the benefit of ICD in patients with ischemic cardiomyopathy compare with those with idiopathic dilated cardiomyopathy, from DANISH trial to real life
Year: 2017
Type: conference-abstract
Abstract: Background: DANISH Trial has questioned the benefit of implantable cardioverter defibrillator (ICD) for primary prevention (PP) in patients (p) with non-ischemic systolic heart failure (NIC-HF). The trial could not demonstrate a reduction in total mortality compared with "usual clinical care". Purpose: To determine the incidence of appropriate therapy (AT) and compare overall (OM), cardiovascular (CM) and non cardiovascular mortality (N-CM) in p with ICD implanted for PP of sudden cardiac death (SCD) in ischemic cardiomyopathy (IC) vs idiopathic dilated cardiomyopathy (IDC). Methods: Between January 2007 and August 2016, 329p were implanted with an ICD. Baseline characteristics, 256p (78%) had IC and 73p (22%) IDC: male 226 (78%) vs 73p (22%) p=0.005, age 64±2 vs 57±11years p=NS, creatinine 1.2±0.5 vs 1.1±0.3mg% p=0.04, NYHA FC I 117 (46%) vs 22p (30%) p=0.01, FC II 106 (41%) vs 33p (45%) p=NS, FC III 32 (12%) vs 16p (22%) p=0.03, LVDD 64±9 vs 69±8mm p<0.001, LVEF 27±7 vs 23±6% p<0.001, inappropriate shocks 25 (10%) vs 13p (18%) p=0.06, Beta-Blockers 247 (96%) vs 69p (95%) p=NS, ACEi/ARB 227 (89%) vs 64p (87%) p=NS, Mineralcorticoid receptor blocker 204 (80%) vs 59p (81%) p=NS, amiodarone 92 (36%) vs 35p (48%) p=0.06, respectively. P who received heart transplant or up-grade to CRT-D were excluded from mortality analysis. Mean follow up 42±37 months (m). Results: During the follow up, 40p (16%) with IC vs 9p (12%) with IDC had AT (p=NS), 27 (11%) vs 7(10%) appropriate shocks and 21 (8%) vs 6 (8%) appropriate ATP (p=NS), respectively. Table 1: Mortality outcomes. Conclusions: DANISH Trial concluded that implantation of an ICD in p who had NIC-HF did not provide an OM benefit. The probability of an ICD reducing OM depends on the ratio of SCD/OM in the studied population. In our studied population, we do not found significant differences between IC and IDC p on the incidence of AT, OM, CM or N-CM. Although, IDC p died later than IC p. As p with IC, p with IDC may benefit from ICD therapy. Table 1 HF: heart failure and AMI: acute myocardial infraction
Source: EP Europace
Authors: A. Tronconi, N. Galizio, J. Gonzalez, F. Robles, A. Palazzo, G. Carnero, M. Mysuta, C. D Amico, G. Lizarraga, F. Figueroa, H. Fraguas
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W2666038751