Advertisement

MADIT II/SCD-HeFT Results: Have They Already Achieved an Impact in Europe?

  • A. Arenal
  • M. Ortiz
Conference paper

Conclusions

The MADIT II study and the SCD-HeFT studies suggest that the ICD reduces total mortality in patients with patients with LV dysfunction. However, the cost-effectiveness of this treatment makes it far from affordable. Better selection of patients that could benefit from an ICD might increase the cost-effectiveness and decrease the percentage of patients in whom an ICD will only produce inappropriate discharges and other undesirable effects. Subgroup analysis has demonstrated a progressive increase in effectiveness of the ICD as QRS duration increases. Little benefit was derived in patients with a QRS of less than 0.12 s, whereas if a QRS duration of 0.15 s was used as a cut-off, a marked reduction in SCD was observed, comparable to that in MUSTT and MADIT I. Similarly, in the SCD-HeFT trial the relative benefits of ICD therapy appeared greater in patients with NYHA class II heart failure, the group in which sudden death is expected to predominate. There seemed to be no benefit in patients with NYHA class III heart failure.

Keywords

Left Ventricular Ejection Fraction Sudden Cardiac Death NYHA Class Multicenter Automate Defibrillator Implantation Trial Optimal Pharmacological Therapy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Moss AJ, Hall WJ, Cannom DS et al (1966) Improved survival with an implanted defibrillator in patients with coronary artery disease at high risk for ventricular arrhythmia. N Engl J Med 335:1933–1940CrossRefGoogle Scholar
  2. 2.
    Buxton AE, Lee KL, Fisher JD et al (1999) A randomized study of the prevention of sudden death in patients with coronary artery disease. N Engl J Med 341:1882–1890PubMedCrossRefGoogle Scholar
  3. 3.
    Moss AJ, Zareba W, Hall WJ et al, for the Multicenter Automatic Defibrillator Implantation Trial II Investigators (2002) Prophylactic implantation of a defibrillator in patients with myocardial infarction and reduced ejection fraction. N Engl J Med 346:877–883PubMedCrossRefGoogle Scholar
  4. 4.
    Bardy GH, Lee KL, Mark DB et al (2004) Sudden Cardiac Death-Heart Failure Trial (SCD-HeFT). Paper presented at American College of Cardiology Annual Scientific Sessions, New Orleans 2004-Late Breaking Trial; 7–10 March 2004, New Orleans, LAGoogle Scholar
  5. 5.
    Reynolds MR, Josephson ME (2003) MADIT II (second Multicenter Automated Defibrillator Implantation Trial) debate: risk stratification, costs, and public policy. Circulation 108:1779–1783PubMedCrossRefGoogle Scholar
  6. 6.
    Marti Almor J, Delclos Baulies M, Delclos Urges J et al (2004) Prevalence and clinical course of patients in Spain with acute myocardial infarction and severely depressed ejection fraction who meet the criteria for automatic defibrillator implantation. Rev Esp Cardiol 57:705–708PubMedCrossRefGoogle Scholar
  7. 7.
    Ortiz M, Arenal A, González-Torrecilla E et al (2004) El desfibrilador automático implantable en la prevención primaria de la muerte súbita. ¿Existen diferencias entre los pacientes según los criterios de selección? Rev Esp Cardiol 57(Suppl 2):141Google Scholar

Copyright information

© Springer-Verlag Italia 2005

Authors and Affiliations

  • A. Arenal
    • 1
  • M. Ortiz
    • 1
  1. 1.Cardiology DepartmentHospital General Universitario Gregorio MarañónMadridSpain

Personalised recommendations