Korean Circ J.  2012 Mar;42(3):173-183. 10.4070/kcj.2012.42.3.173.

The Relevance of the Primary Prevention Criteria for Implantable Cardioverter Defibrillator Implantation in Korean Symptomatic Severe Heart Failure Patients

• Kim J
• Choi EK
• Lee MH
• Kang DY
• Sung YJ
• Lee DW
• Oh I
• Choi YS
• Oh S

• KMID: 2225031
• DOI: http://doi.org/10.4070/kcj.2012.42.3.173

Abstract

BACKGROUND AND OBJECTIVES
Implantable cardioverter defibrillator (ICD) therapy is recommended as the primary tool for prevention of sudden cardiac death (SCD) in symptomatic patients with severe left ventricular dysfunction. There is a paucity of information on whether this recommendation is appropriate for the Korean population with severe heart failure.
SUBJECTS AND METHODS
The study group consisted of 275 consecutive patients (mean age 65 years, 71% male) who met the ICD implantation criteria for primary prevention (left ventricular ejection fraction < or =30% and New York Heart Association functional class II or III). We analyzed the clinical characteristics and outcomes of an ischemic cardiomyopathy (ICMP) group (n=131) and a non-ischemic cardiomyopathy (NICMP) group (n=144). The outcomes of these 2 groups were compared with the Multicenter Automatic Defibrillator Implantation Trial II (MADIT-II) conventional and Defibrillators in the Non-ischemic Cardiomyopathy Treatment Evaluation (DEFINITE) standard therapy groups, respectively.
RESULTS
Eighty patients (29%) died during a follow-up period of 40+/-17 months. The NICMP group had better all-cause mortality rates than the ICMP group (19% vs. 40%, p<0.001), however both groups had a similar incidence of SCD (7% vs. 10%, p=0.272). The 2-year all-cause mortality and SCD for the ICMP group were similar to those of the MADIT-II conventional therapy group (20% vs. 20%, 7% vs. 10%, respectively, all p>0.05). All-cause mortality and the incidence of SCD in the NICMP group were comparable to those of the DEFINITE standard therapy group (13% vs. 17%, 6% vs. 6%, respectively, all p>0.05).
CONCLUSION
Korean patients with severe heart failure in both the ICMP and NICMP groups had all-caused mortality and risk of SCD comparable to patients in the MADIT-II and DEFINITE standard therapy groups. Therefore, the primary prevention criteria for ICD implantation would be appropriate in both Korean ICMP and NICMP patients.

Keyword

Heart failure; Implantable defibrillators; Death, sudden, cardiac

MeSH Terms

Cardiomyopathies
Death, Sudden, Cardiac
Defibrillators
Defibrillators, Implantable
Follow-Up Studies
Heart
Heart Failure
Humans
Incidence
New York
Primary Prevention
Stroke Volume
Ventricular Dysfunction, Left

Figure

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  Fig. 1 Kaplan-Meier curves of survival. A: probability of survival (death from any cause). B: cumulative probability of sudden cardiac death. ICMP: ischemic cardiomyopathy, NICMP: non-ischemic cardiomyopathy.

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  Fig. 2 Comparison of survival between ICMP group and MADIT-II conventional therapy group. A: probability of survival (death from any cause). B: cumulative probability of sudden cardiac death. ICMP: ischemic cardiomyopathy, CTx: conventional treatment, MADIT-II: Multicenter Automatic Defibrillator Implantation Trial II.

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  Fig. 3 Comparison of survival between NICMP and DEFINITE standard therapy group. A: probability of survival (death from any cause). B: cumulative probability of survival (sudden cardiac death). NICMP: non-ischemic cardiomyopathy, DEFINITE: Defibrillators in Non-Ischemic Cardiomyopathy Treatment Evaluation Trial.

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