Comparison of efficacy of implanted cardioverter-defibrillator in patients with versus without diabetes mellitus.
In the second Multicenter Automatic Defibrillator Implantation Trial, patients with a previous myocardial infarction and left ventricular ejection fraction < or =0.30 benefited significantly from prophylactic implantable cardioverter-defibrillator (ICD) placement. Diabetic patients who had a myocardial infarction had a worse prognosis compared with nondiabetics. The present study used data from the second Multicenter Automatic Defibrillator Implantation Trial to assess the efficacy of ICD placement on survival in diabetic patients. Of the 1,232 patients in the second Multicenter Automatic Defibrillator Implantation Trial, 489 were characterized as diabetic. They were more likely to be New York Heart Association class II to IV, be hypertensive, have renal dysfunction, have an increased body mass index, and to take diuretic drugs. Diabetic patients had a 24% greater adjusted risk of death than nondiabetic patients. The hazard ratio (HR) for the risk of death in patients treated with the ICD compared with conventional therapy was similar in diabetics (HR 0.61; 95% confidence interval [CI] 0.38 to 0.98) and nondiabetics (HR 0.71; 95% CI 0.49 to 1.05), with no evidence of interaction. Thus, diabetic patients derive a similar benefit from ICD therapy despite being sicker and having a higher mortality rate overall.
Wittenberg
Stephen M
SM
Department of Medicine, Tufts University School of Medicine and Baystate Medical Center, Springfield, Massachusetts, USA. stephen.wittenberg@bhs.org
Cook
James R
JR
Hall
W Jackson
WJ
McNitt
Scott
S
Zareba
Wojceich
W
Moss
Arthur J
AJ
D000368:Aged; D017147:Defibrillators, Implantable; D048909:Diabetes Complications / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D009203:Myocardial Infarction / Q000503:physiopathology* / Q000517:prevention & control*; D016016:Proportional Hazards Models; D016032:Randomized Controlled Trials as Topic; D013318:Stroke Volume; D018487:Ventricular Dysfunction, Left / Q000503:physiopathology*