title: Implantable cardioverter-defibrillator therapy among patients with non-ischaemic vs. ischaemic cardiomyopathy for primary prevention of sudden cardiac death.
abstract: The magnitude of benefit related to implantable cardioverter defibrillator (ICD) therapy for primary prevention of sudden cardiac death (SCD) in non-ischaemic cardiomyopathy (NICM) and ischaemic cardiomyopathy (ICM) has not been evaluated extensively in clinical practice.
  
  
  
  Of the 5539 consecutive patients enrolled in the multicentre Défibrillateur Automatique Implantable-Prévention Primaire (DAI-PP) study (2002-12), 5485 patients (with information on underlying heart disease) were included in the present analysis: 2181 (39.8%) had NICM and 3304 (60.2%) had ICM. ICM patients were older (63.7 ±10.3 vs. 60.6 ± 12.2 years, P < 0.0001), with a higher ejection fraction [27% (25-30) vs. 25% (20-30), P < 0.0001], narrower QRS (37.3% vs. 21.4% with QRS <120, P < 0.0001), and higher prevalence of sinus rhythm (77.3% vs. 74.0%, P = 0.009). During a mean follow-up of 3.1 ± 2.2 years, 814 patients died, giving a mortality incidence of 48.6 per 1000 person-years [95% confidence interval (CI) 45.2-51.9], higher among ICM patients (52.3, 95% CI 47.8-56.7) than in NICM patients (42.4, 95% CI 37.3-47.6; P = 0.008) (adjusted hazard ratio 1.31, 95% CI 1.06-1.61, P = 0.01). The increase in mortality among ICM patients was mainly due to non-cardiovascular mortality (P = 0.0002), whereas incidences of cardiovascular mortality (including ICD-unresponsive SCD) were similar in the two groups. Incidences of appropriate ICD interventions (anti-tachycardia pacing, shocks) were similar, but inappropriate therapies were more frequent in NICM (7.94 vs. 5.96%; P = 0.005).
  
  
  
  NICM and ICM patients had a same rate of ICD therapy for primary prevention of SCD in everyday practice. But, ICM patients more often died of a non- cardiovascular cause of death.
  
  
  
  NCT 01992458.
authors.affiliation: CHU Pontchaillou, Université de Rennes 1, Rennes, France.
authors.forename: Nelly
authors.initials: N
authors.lastname: Amara
authors.affiliation: Clinique Pasteur, Toulouse, France.
authors.forename: Serge
authors.initials: S
authors.lastname: Boveda
authors.affiliation: CHU Michallon, Grenoble, France.
authors.forename: Pascal
authors.initials: P
authors.lastname: Defaye
authors.affiliation: CHRU Lille, Lille, France.
authors.forename: Didier
authors.initials: D
authors.lastname: Klug
authors.affiliation: Clinique Saint Joseph, Angers, France.
authors.forename: Fréderic
authors.initials: F
authors.lastname: Treguer
authors.affiliation: European Georges Pompidou Hospital and Paris Descartes University, Paris, France.
authors.forename: Denis
authors.initials: D
authors.lastname: Amet
authors.affiliation: Paris Cardiovascular Research Center, Inserm U970, Paris, France.
authors.forename: Marie-Cécile
authors.initials: MC
authors.lastname: Perier
authors.affiliation: Nouvelles Cliniques Nantaises, Nantes, France.
authors.forename: Daniel
authors.initials: D
authors.lastname: Gras
authors.affiliation: CHU Antoine Béclère, Clamart, France.
authors.forename: Vincent
authors.initials: V
authors.lastname: Algalarrondo
authors.affiliation: Paris Cardiovascular Research Center, Inserm U970, Paris, France.|CHU Antoine Béclère, Clamart, France.
authors.forename: Abdeslam
authors.initials: A
authors.lastname: Bouzeman
authors.affiliation: Centre Cardiologique du Nord, Saint Denis, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Piot
authors.affiliation: CHU La Timone, Marseille, France.
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Deharo
authors.affiliation: CHU Trousseau, Tours, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Fauchier
authors.affiliation: CHU Trousseau, Tours, France.
authors.forename: Dominique
authors.initials: D
authors.lastname: Babuty
authors.affiliation: CHU Haut Lévêque, Bordeaux, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Bordachar
authors.affiliation: CHU Brabois, Nancy, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Sadoul
authors.affiliation: European Georges Pompidou Hospital and Paris Descartes University, Paris, France.|Paris Cardiovascular Research Center, Inserm U970, Paris, France.
authors.forename: Eloi
authors.initials: E
authors.lastname: Marijon
authors.affiliation: CHU Pontchaillou, Université de Rennes 1, Rennes, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Leclercq
mesh_terms: D000368:Aged; D009202:Cardiomyopathies / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D002423:Cause of Death; D016757:Death, Sudden, Cardiac / Q000453:epidemiology / Q000517:prevention & control*; D017147:Defibrillators, Implantable; D004554:Electric Countershock / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality / Q000503:physiopathology; D011322:Primary Prevention / Q000295:instrumentation*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: Cardiac arrest; Complications; Mortality; Shock; Therapies