title: Mortality Effect of ICD in Primary Prevention of Nonischemic Cardiomyopathy: A Meta-Analysis of Randomized Controlled Trials.
abstract: BACKGROUND
  Implantation of an implantable cardioverter defibrillator (ICD) for primary prevention of sudden cardiac death (SCD) is controversial in view of the recent DANISH trial which suggested no benefit with ICD for primary prevention in patients with non-ischemic cardiomyopathy (NICMP).
  
  
  METHODS
  We conducted a meta-analysis of randomized control trials studying the role of ICD in primary prevention of SCD in patients with NICMP. Only six studies were identified after the application of inclusion/exclusion criteria.
  
  
  RESULTS
  Pooling of these randomized trials showed a statistically significant benefit of using ICDs in patients with NICMP [OR 0.76 (0.64 - 0.91), I2= 0%]. Sensitivity analysis did not show a statistically significant mortality benefit of ICD in NICMP in trials which had adequate beta blocker, ACE/ARB and aldosterone receptor blocker (ALD-RB) use [OR 0.70 (0.41, 1.19), I2= 70%].
  
  
  CONCLUSIONS
  The DANISH trial's failure to show mortality benefit may be due to the significant number of patients who had CRT. Our meta-analysis studied the independent effect of ICDs and showed them to be associated with net mortality benefits in patients who are not on optimal guideline directed medical therapy; especially the patients not on ALD-RB.
authors.affiliation: Mercy Saint Vincent Medical Center, Toledo, Ohio, USA.
authors.forename: Faraz Khan
authors.initials: FK
authors.lastname: Luni
authors.affiliation: Mercy Saint Vincent Medical Center, Toledo, Ohio, USA.
authors.forename: Hemindermeet
authors.initials: H
authors.lastname: Singh
authors.affiliation: University of Louisville, Louisville, Kentucky, USA.
authors.forename: Abdur R
authors.initials: AR
authors.lastname: Khan
authors.affiliation: Mercy Saint Vincent Medical Center, Toledo, Ohio, USA.
authors.forename: Sonia A
authors.initials: SA
authors.lastname: Malik
authors.affiliation: Mercy Saint Vincent Medical Center, Toledo, Ohio, USA.
authors.forename: Owais
authors.initials: O
authors.lastname: Khawaja
authors.affiliation: Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: Haris
authors.initials: H
authors.lastname: Riaz
authors.affiliation: University of Toledo Medical Center, Toledo, Ohio, USA.
authors.forename: Wade
authors.initials: W
authors.lastname: Lee
authors.affiliation: Mercy Saint Vincent Medical Center, Toledo, Ohio, USA.
authors.forename: Ameer
authors.initials: A
authors.lastname: Kabour
authors.affiliation: Toledo Hospital, Toledo, Ohio, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Richards
authors.affiliation: Toledo Hospital, Toledo, Ohio, USA.
authors.forename: Johan
authors.initials: J
authors.lastname: Aasbo
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D057911:Angiotensin Receptor Antagonists / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D009202:Cardiomyopathies / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D016009:Chi-Square Distribution; D016757:Death, Sudden, Cardiac / Q000209:etiology / Q000517:prevention & control*; D017147:Defibrillators, Implantable; D004554:Electric Countershock / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D006801:Humans; D008875:Middle Aged; D000451:Mineralocorticoid Receptor Antagonists / Q000627:therapeutic use; D016017:Odds Ratio; D011322:Primary Prevention / Q000295:instrumentation*; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D000319:Adrenergic beta-Antagonists; D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000451:Mineralocorticoid Receptor Antagonists
keywords: DANISH trial; implantable cardioverter defibrillator; meta-analysis; nonischemic cardiomyopathy; sudden cardiac death