AI Article Synopsis
- The Improve SCA trial highlights the underutilization of implantable cardioverter-defibrillators (ICDs) in regions like Asia, Latin America, and Africa, showing their potential benefits for patients with ischemic (ICM) and non-ischemic cardiomyopathy (NICM) who are at risk of sudden cardiac arrest (SCA).
- Out of 1848 non-ischemic and 581 ischemic cardiomyopathy patients, those who received ICDs had significantly lower all-cause mortality rates at 3 years compared to those without the devices, indicating a strong mortality benefit.
- The study concludes that ICD implantation is crucial for improving survival in primary prevention patients and that the rate of appropriate device therapy is
Article Abstract
Background & Objective: Despite the burden of sudden cardiac arrest (SCA) worldwide, implantable cardioverter-defibrillators (ICDs) are underutilized, particularly in Asia, Latin America, Eastern Europe, the Middle East, and Africa. The Improve SCA trial demonstrated that primary prevention (PP) patients in these regions benefit from an ICD or a cardiac resynchronization therapy defibrillator (CRT-D). We aimed to compare the rate of device therapy and mortality among ischemic and non-ischemic cardiomyopathy (ICM and NICM) PP patients who met guideline indications for ICD therapy and had an ICD/CRT-D implanted.
Methods: Improve SCA was a prospective, non-randomized, non-blinded multicenter trial that enrolled patients from the above-mentioned regions. All-cause mortality and device therapy were examined by cardiomyopathy (ICM vs NICM) and implantation status. Cox proportional hazards methods were used, adjusting for factors affecting mortality risk.
Results: Of 1848 PP NICM patients, 1007 (54.5%) received ICD/CRT-D, while 303 of 581 (52.1%) PP ICM patients received an ICD/CRT-D. The all-cause mortality rate at 3 years for NICM patients with and without an ICD/CRT-D was 13.1% and 18.3%, respectively (HR 0.51, 95% CI 0.38-0.68, p < 0.001). Similarly, all-cause mortality at 3 years in ICM patients was 13.8% in those with a device and 19.9% in those without an ICD/CRT-D (HR 0.54, 95% CI 0.33-.0.88, p = 0.011). The time to first device therapy, time to first shock, and time to first antitachycardia pacing (ATP) therapy were not significantly different between groups (p ≥ 0.263).
Conclusions: In this large data set of patients with a guideline-based PP ICD indication, defibrillator device implantation conferred a significant mortality benefit in both NICM and ICM patients. The rate of appropriate device therapy was also similar in both groups.
Clinical Trial Registration: ClinicalTrials.gov ID: NCT02099721.
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| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC10123448 | PMC |
| http://dx.doi.org/10.1016/j.ihj.2023.01.010 | DOI Listing |
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