Ischaemic cardiomyopathy: presence of ICD linked to lower risk for all-cause mortality

  • Lee TC & al.
  • ESC Heart Fail
  • 27 Feb 2019

  • curated by Sarfaroj Khan
  • UK Clinical Digest
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Takeaway

  • In this propensity-matched, retrospective analysis of data from the WARCEF (Warfarin Versus Aspirin in Reduced Cardiac Ejection Fraction) trial, the presence of implantable cardioverter-defibrillator (ICD) at baseline was associated with survival benefits in patients with ischaemic cardiomyopathy (ICM) but not in those with non-ischaemic cardiomyopathy (NICM).

Why this matters

  • Findings are broadly consistent with the recent literature suggesting that the effect of ICD may be attenuated in patients with NICM.

Study design

  • Propensity-matched, retrospective analysis of data from the WARCEF trial (ICM, n=991; NICM, n=1302).
  • 1:2 propensity-matched cohorts for patients with ICM (with ICD, 223; matched, 446) and patients with NICM (with ICD, 195; matched, 390).
  • Primary outcome: all-cause mortality.
  • Funding: WARCEF trial was supported by grants from the National Institute of Neurological Disorders and Stroke.

Key results

  • Of the 2293 WARCEF participants, 418 had an ICD at time of enrolment.
  • 527 deaths were recorded during a mean follow-up of 3.5 ± 1.8 years.
  • Presence of ICD at baseline was significantly associated with lower mortality among patients with ICM (HR, 0.64; 95% CI, 0.44-0.91; P=.015).
  • ICD status did not predict mortality among patients with NICM (HR, 0.98; 95% CI, 0.64-1.50; P=.941)
  • There was weak evidence of interaction between ICD status and the aetiology of heart failure (P=.131).

Limitations

  • Post hoc analysis.
  • Residual confounding.