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JAMA Cardiol. 2017 Jun 1;2(6):685-688. doi: 10.1001/jamacardio.2017.0630.

Primary Prevention Implantable Cardioverter Defibrillators in Patients With Nonischemic Cardiomyopathy: A Meta-analysis.

Author information

1
Division of Cardiology, Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina.
2
Division of Cardiology, UCLA (University of California, Los Angeles).
3
Division of Cardiology, University of Texas Southwestern, Dallas.
4
Department of Biostatistics, University of Washington, Seattle.
5
Department of Biostatistics and Bioinformatics, Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina.
6
Division of Cardiology, Feinberg School of Medicine, Northwestern Memorial Hospital, Chicago, Illinois.
7
Division of Cardiology, University of Washington, Seattle.
8
Department of Clinical Pharmacology, Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina.

Abstract

Importance:

Conflicting data have emerged on the efficacy of implantable cardioverter defibrillators (ICDs) for primary prevention of sudden cardiac death (primary prevention ICDs) in patients with nonischemic cardiomyopathy.

Objective:

To investigate the association of primary prevention ICDs with all-cause mortality in patients with nonischemic cardiomyopathy.

Data Sources:

PubMed was searched from January 1, 2000, through October 31, 2016, for the terms implantable defibrillator OR implantable cardioverter defibrillator AND non-ischemic cardiomyopathy. Additional references were identified from bibliographies of pertinent articles and queries to experts in this field.

Study Selection:

Inclusion criteria consisted of a randomized clinical trial design and comparison of the ICD with medical therapy (control) in at least 100 patients with nonischemic cardiomyopathy. In addition, studies had to report on all-cause mortality during a follow-up period of at least 12 months and be published in English. The search yielded 10 studies, of which only 1 met the inclusion criteria. A search of bibliographies of pertinent articles and queries of experts in this field led to 3 additional studies.

Data Extraction and Synthesis:

The PRISMA guidelines were used to abstract data and assess data quality and validity. Data were pooled using fixed- and random-effects models.

Main Outcomes and Measures:

The primary end point was all-cause mortality. Before data collection started, primary prevention ICDs were hypothesized to reduce all-cause mortality among patients with nonischemic cardiomyopathy.

Results:

Four randomized clinical trials met the selection criteria and included 1874 unique patients; 937 were in the ICD group and 937 in the control group. Pooling data from these trials showed a significant reduction in all-cause mortality with an ICD (hazard ratio, 0.75; 95% CI, 0.61-0.93; Pā€‰=ā€‰.008; Pā€‰=ā€‰.87 for heterogeneity).

Conclusions and Relevance:

Primary prevention ICDs are efficacious at reducing all-cause mortality among patients with nonischemic cardiomyopathy. These findings support professional guidelines that recommend the use of ICDs in such patients.

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