title: The relevance of the primary prevention criteria for implantable cardioverter defibrillator implantation in korean symptomatic severe heart failure patients.
abstract: OBJECTIVE
  Implantable cardioverter defibrillator (ICD) therapy is recommended as the primary tool for prevention of sudden cardiac death (SCD) in symptomatic patients with severe left ventricular dysfunction. There is a paucity of information on whether this recommendation is appropriate for the Korean population with severe heart failure.
  
  
  METHODS
  The study group consisted of 275 consecutive patients (mean age 65 years, 71% male) who met the ICD implantation criteria for primary prevention (left ventricular ejection fraction ≤30% and New York Heart Association functional class II or III). We analyzed the clinical characteristics and outcomes of an ischemic cardiomyopathy (ICMP) group (n=131) and a non-ischemic cardiomyopathy (NICMP) group (n=144). The outcomes of these 2 groups were compared with the Multicenter Automatic Defibrillator Implantation Trial II (MADIT-II) conventional and Defibrillators in the Non-ischemic Cardiomyopathy Treatment Evaluation (DEFINITE) standard therapy groups, respectively.
  
  
  RESULTS
  Eighty patients (29%) died during a follow-up period of 40±17 months. The NICMP group had better all-cause mortality rates than the ICMP group (19% vs. 40%, p<0.001), however both groups had a similar incidence of SCD (7% vs. 10%, p=0.272). The 2-year all-cause mortality and SCD for the ICMP group were similar to those of the MADIT-II conventional therapy group (20% vs. 20%, 7% vs. 10%, respectively, all p>0.05). All-cause mortality and the incidence of SCD in the NICMP group were comparable to those of the DEFINITE standard therapy group (13% vs. 17%, 6% vs. 6%, respectively, all p>0.05).
  
  
  CONCLUSIONS
  Korean patients with severe heart failure in both the ICMP and NICMP groups had all-caused mortality and risk of SCD comparable to patients in the MADIT-II and DEFINITE standard therapy groups. Therefore, the primary prevention criteria for ICD implantation would be appropriate in both Korean ICMP and NICMP patients.
authors.affiliation: Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.
authors.forename: Jiyeong
authors.initials: J
authors.lastname: Kim
authors.forename: Eue-Keun
authors.initials: EK
authors.lastname: Choi
authors.forename: Min-Ho
authors.initials: MH
authors.lastname: Lee
authors.forename: Do-Yoon
authors.initials: DY
authors.lastname: Kang
authors.forename: Young-Jun
authors.initials: YJ
authors.lastname: Sung
authors.forename: Dong-Won
authors.initials: DW
authors.lastname: Lee
authors.forename: Ilyoung
authors.initials: I
authors.lastname: Oh
authors.forename: Yun-Shik
authors.initials: YS
authors.lastname: Choi
authors.forename: Seil
authors.initials: S
authors.lastname: Oh