title: Appropriate therapies predict long-term mortality in primary and secondary prevention of sudden cardiac death.
abstract: BACKGROUND
  Less than 50% of patients implanted with an implantable cardioverter-defibrillator (ICD) receive device therapy during the follow-up. The aim of our study was to prospectively evaluate the predictive role of appropriate ICD therapy on long-term survival of patients implanted for primary or secondary sudden death prevention.
  
  
  METHODS
  From 2002 to 2003, 139 consecutive patients [mean age 66±9 years, male 77%, ischemic heart disease 56%, New York Heart Association functional class >II (74%), primary prevention 74%, mean left ventricular ejection fraction 30±9%, cardiac resynchronization ICD 65%] were enrolled. We collected and evaluated device therapies for at least 18 months and recorded survival status for more than 5 years.
  
  
  RESULTS
  Over a median follow-up of 18 months, 54 (39%) patients received at least one ICD intervention, with 28 patients receiving only appropriate ICD therapies, 13 only inappropriate therapies and 13 receiving both therapies. At a mean follow-up of 63±12 months, 30 deaths occurred in 130 patients (23%); for nine patients, we had no survival status information. Death was classified as cardiac in 22 (73%) patients, the most common cause was progressive heart failure. In a Cox proportional regression model, an appropriate ICD therapy was associated with a significant increase in the subsequent risk of death (hazard ratio 3.02, P=0.003).
  
  
  CONCLUSIONS
  In patients implanted with ICD or cardiac resynchronization therapy with ICD devices, for primary or secondary sudden cardiac death prevention, appropriate ICD therapy predicts a three-fold greater risk of death.
authors.affiliation: Clinica Mediterranea, Naples, Italy. gmrstabile@tin.it
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Stabile
authors.forename: Carlo
authors.initials: C
authors.lastname: D'Agostino
authors.forename: Paolo
authors.initials: P
authors.lastname: Gallo
authors.forename: Natale
authors.initials: N
authors.lastname: Marrazzo
authors.forename: Assunta
authors.initials: A
authors.lastname: Iuliano
authors.forename: Antonio
authors.initials: A
authors.lastname: De Simone
authors.forename: Pietro
authors.initials: P
authors.lastname: Turco
authors.forename: Michele
authors.initials: M
authors.lastname: Palella
authors.forename: Giovanni
authors.initials: G
authors.lastname: Donnici
authors.forename: Carmine
authors.initials: C
authors.lastname: Ciardiello
authors.forename: Giovanni
authors.initials: G
authors.lastname: Napolitano
authors.forename: Francesco
authors.initials: F
authors.lastname: Solimene
mesh_terms: D000368:Aged; D001145:Arrhythmias, Cardiac / Q000150:complications / Q000401:mortality / Q000628:therapy*; D058406:Cardiac Resynchronization Therapy / Q000379:methods*; D016757:Death, Sudden, Cardiac / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D008297:Male; D011322:Primary Prevention / Q000379:methods*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D055502:Secondary Prevention / Q000379:methods*; D015996:Survival Rate / Q000639:trends; D013997:Time Factors