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Patients with severe cardiac dysfunction benefit most from ICDs

מתוך medicontext.co.il

By Steven Reinberg

WESTPORT, CT (Reuters Health) – The greatest survival benefit from implanted cardioverter-defibrillators (ICDs) is seen in patients with the most severe cardiac dysfunction, according to a report in the September 1st issue of The American Journal of Cardiology.

Dr. Arthur J. Moss from the University of Rochester Medical Center, New York, and colleagues looked at survival among 196 patients who participated in the Multicenter Automatic Defibrillator Implantation Trial.

Patients were classified as high-risk or low-risk according to ejection fraction, QRS duration and history of heart failure needing therapy. The subjects were randomized to conventional medical treatment or to receive an implanted defibrillator.

During an average follow-up of 27 months, 54 patients died. Those in the high-risk group (ejection fractions < 0.26, QRS width 0.12 seconds or longer and a history of CHF requiring treatment) had a higher mortality rate than patients in the low-risk group, the researchers report.

The results of Kaplan-Meier analysis showed that the survival benefit with an ICD was significantly greater than with conventional therapy (p < 0.01) for high-risk patients (p =0.002). However, Dr. Moss' group noted only a nonsignificant trend toward greater survival among low-risk patients who received an ICD.

The number of mortality risk factors was directly related to the overall risk of death (p < 0.01 for trend). As mortality risk increased, ICD treatment was progressively and significantly associated with an improvement in survival (p = 0.19 for trend), the researchers found.

Patients with ICDs who were mildly or moderately ill had a 20% to 30% reduction in mortality and those with moderate to severe heart disease had a 50% to 60% reduction in mortality. Patients who were very severely ill had a 75% reduction in mortality, Dr. Moss told Reuters Health.

"By the same token, the people who were the least sick did not get very much benefit from the device. This means that we can identify people who would not need an ICD and those who do. For example, there is a cadre of patients on heart transplant lists who could benefit from ICDs," he noted.

"The bottom line is that the sicker the patient, the greater the benefit from the ICD," Dr. Moss said.

Am J Cardio 2001;88:516-520.

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