ICD Primary prevention trials
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TABLE 1. Overview of the Major Randomized Controlled Clinical Trials of ICD Therapy for Primary Prevention of Sudden Cardiac Death in Ischemic Cardiomyopathy | |||||
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Study | Inclusion Criteria | Number Randomized | Control Group | Primary Point | Main Finding |
MADIT I35 | Prior MI, EF ≤35%, NSVT, inducible and nonsuppressible VT on EPS, NYHA class I–III | 196 | Conventional therapy | All-cause mortality | 54% RRR in all-cause
mortality with ICD (P=0.009); absolute RR 23% |
CABG-PATCH36 | EF <35%, abnormal SAECG, elective CABG | 900 | Conventional therapy | All-cause mortality | No difference in all-cause mortality |
MUSTT37 | Prior MI, EF ≤40%, NSVT, inducible VT on EPS | 704 | EP-guided antiarrhythmic therapy or conventional therapy | Cardiac arrest or death due to arrhythmia | 60% RRR in all-cause mortality with ICD (P=0.001); absolute RR 31% |
MADIT II39 | Prior MI≤1 month, EF≤30%, NYHA class I–III | 1232 | Conventional therapy | All-cause mortality | 31% RRR in all-cause mortality with ICD (P=0.016); absolute RR 6% |
DINAMIT38 | Recent (6–40 days) MI, EF≤35%, abnormal HRV or elevated average HR on 24-h Holter, NYHA class I–III | 674 | Conventional therapy | All-cause mortality | No difference in all-cause mortality; 58% RRR from arrhythmia with ICD (P=0.009) |
SCD-HeFT34 | EF≤35%, (ischemic or nonischemic) NYHA class II–III | 2521 | Conventional therapy±amiodarone | All-cause mortality | 23% RRR in all-cause mortality with ICD (P=0.007); absolute RR 7% |
EF indicates ejection fraction; NSVT, nonsustained VT; EPS, electrophysiological study; NYHA, New York Heart Association; RRR, relative risk reduction; RR, risk reduction; CABG, coronary artery bypass grafting; SAECG, signal-averaged ECG; HRV, heart rate variability; and HR, heart rate. |