Long-term benefit of primary prevention with an implantable cardioverter-defibrillator: An extended 8-year follow-up study of the multicenter automatic defibrillator implantation trial II

Ilan Goldenberg*, John Gillespie, Arthur J. Moss, W. Jackson Hall, Helmut Klein, Scott McNitt, Mary W. Brown, Iwona Cygankiewicz, Wojciech Zareba

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Background-: The Multicenter Automatic Defibrillator Implantation Trial II (MADIT-II) showed a significant 31% reduction in the risk of death with primary implantable cardioverter-defibrillator (ICD) therapy during a median follow-up of 1.5 years. However, currently there are no data on the long-term efficacy of primary defibrillator therapy. Methods And Results-: MADIT-II enrolled 1232 patients with ischemic left ventricular dysfunction who were randomized to ICD and non-ICD medical therapy and were followed up through November 2001. For the present long-term study, we acquired posttrial mortality data through March 2009 for all study participants (median follow-up, 7.6 years). Multivariate Cox proportional hazards regression modeling was performed to calculate the hazard ratio for ICD versus non-ICD therapy during long-term follow-up. At 8 years of follow-up, the cumulative probability of all-cause mortality was 49% among patients treated with an ICD compared with 62% among non-ICD patients (P<0.001). Multivariate analysis demonstrated that ICD therapy was associated with a significant long-term survival benefit (hazard ratio for 0-through 8-year mortality=0.66 [95% confidence interval, 0.56 to 0.78]; P<0.001). Treatment with an ICD was shown to be associated with a significant reduction in the risk of death during the early phase of the extended follow-up period (0 through 4 years: hazard ratio=0.61 [95% confidence interval, 0.50 to 0.76]; P<0.001) and with continued life-saving benefit during the late phase of follow-up (5 through 8 years: hazard ratio=0.74 [95% confidence interval, 0.57 to 0.96]; P=0.02). Conclusions-: Our findings demonstrate a sustained 8-year survival benefit with primary ICD therapy in the MADIT-II population.

Original languageEnglish
Pages (from-to)1265-1271
Number of pages7
JournalCirculation
Volume122
Issue number13
DOIs
StatePublished - 28 Sep 2010
Externally publishedYes

Keywords

  • death, sudden
  • defibrillation
  • mortality

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