Are the MADIT II criteria for ICD implantation appropriate for Japanese patients?
BACKGROUND
The Multicenter Automatic Defibrillator Implantation Trial (MADIT) II investigators concluded that prophylactic use of an implantable cardioverter defibrillator (ICD) improved survival in patients with prior myocardial infarction (MI) and reduced the left ventricular ejection fraction (LVEF). However, it is unclear whether MADIT II criteria for ICD implantation are appropriate for Japanese patients.


RESULTS
During the period 1997 to 2001 90 (M/F: 75/15; mean age: 65+/-9 years) of the 3,258 patients who underwent elective cardiac catheterization met MADIT II criteria (Q-wave MI more than 4 weeks prior; LVEF <or=0.30; >21 years of age; electrophysiologic testing not required) and were selected in this retrospective study of patient prognosis after catheterization. During the 37+/-12-month follow-up period, 15 patients died of congestive heart failure (n=9), sudden cardiac death (n=2), acute MI (n=1), or noncardiac causes (n=3). The survival rate in the present series was comparable with that in the MADIT II defibrillator group, but higher than that in the MADIT II conventional therapy group. A significantly greater percentage of the present patients were found to be in New York Heart Association class I and have undergone percutaneous coronary intervention than in MADIT II.


CONCLUSIONS
These results suggest that it may be inappropriate to apply MADIT II criteria to Japanese patients.
Tanno
Kaoru
K
Third Department of Internal Medicine, Showa University School of Medicine, Tokyo, Japan. k-tanno@p02.itscom.net
Miyoshi
Fumito
F
Watanabe
Norikazu
N
Minoura
Yoshino
Y
Kawamura
Mitsuharu
M
Ryu
Syunsho
S
Asano
Taku
T
Kobayashi
Youichi
Y
Katagiri
Takashi
T
D000368:Aged; D001026:Coronary Artery Bypass / Q000706:statistics & numerical data; D017147:Defibrillators, Implantable / Q000592:standards*; D003920:Diabetes Mellitus / Q000453:epidemiology; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000628:therapy*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D016019:Survival Analysis; D017741:Survivors; D016277:Ventricular Function, Left