Predictors of long-term mortality in Multicenter Automatic Defibrillator Implantation Trial II (MADIT II) patients with implantable cardioverter-defibrillators

Iwona Cygankiewicz*, John Gillespie, Wojciech Zareba, Mary W. Brown, Ilan Goldenberg, Helmut Klein, Scott McNitt, Slava Polonsky, Mark Andrews, Edward M. Dwyer, W. Jackson Hall, Arthur J. Moss

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

64 Scopus citations

Abstract

Background: Data on long-term follow-up and factors influencing mortality in implantable cardioverter-defibrillator (ICD) recipients are limited. Objective: The aim of this study was to evaluate mortality during long-term follow-up and the predictive value of several risk markers in the Multicenter Automatic Defibrillator Implantation Trial II (MADIT II) patients with implanted cardioverter-defibrillators (ICDs). Methods: The study involved U.S. patients from the MADIT II trial randomized to and receiving ICD treatment. Data regarding long-term mortality were retrieved from the National Death Registry. Several clinical, biochemical, and electrocardiogram variables were tested in a multivariate Cox model for predicting long-term mortality, and a score identifying high-, medium-, and lower risk patients was developed. Results: The study population consisted of 655 patients, mean age 64 ± 10 years. During a follow-up of up to 9 years, averaging 63 months, 294 deaths occurred. The 6-year cumulative probability of death was 40%, with evidence of a constant risk of about 8.5% per year among survivors. Median survival was estimated at 8 years. Multivariate analysis identified age >65 years, New York Heart Association class 3-4, diabetes, non-sinus rhythm, and increased levels of blood urea nitrogen as independent risk predictors of mortality. Patients with three or more of these risk factors were characterized by a 6-year mortality rate of 68%, compared with 43% in those with one to two risk factors and 19% in patients with no risk factors. Conclusion: A combination of a few readily available clinical variables indicating advanced disease and comorbid conditions identifies ICD patients at high risk of mortality during long-term follow-up.

Original languageEnglish
Pages (from-to)468-473
Number of pages6
JournalHeart Rhythm
Volume6
Issue number4
DOIs
StatePublished - Apr 2009
Externally publishedYes

Funding

FundersFunder number
Guidant Corporation

    Keywords

    • Implantable cardioverter-defibrillator
    • Mortality
    • Risk stratification

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