Abstract 12506: Implantable Cardioverter Defibrillators for Primary Prevention in Patients With Ischemic and Non Ischemic Cardiomyopathy: A Meta-Analysis of 15 Randomized Controlled Trial

Abstract

Background: The evidence to support implantable cardioverter defibrillator (ICD) in patients with ischemic and nonischemic cardiomyopathy for prevention of sudden cardiac death (SCD) is not robust, with conflicting results in randomized controlled trials. Objective: We aim to evaluate the impact of ICD therapy with conventional care for the primary prevention of death of various causes in adults with ischemic and nonischemic cardiomyopathy. Methods: We performed a systematic literature search on the electronic database for relevant articles from inception until 15th May 2022. Results: A total of 15 randomized controlled trials involving 9,999 patients: 9 (6523 patients) addressed ischemic cardiomyopathy, and 6 studies (3476 patients) reported nonischemic cardiomyopathy. The mean follow-up duration was 3.02 years. Pooled analysis showed that ICD therapy significantly reduced the risk of ACM (HR, 0.75(95%CI: 0.64-0.88), P<0.001) from the control group. The magnitude of reduction was similar with ischemic (HR, 0.75(95%CI: 0.58-0.96), P=0.02), nonischemic (HR, 0.76(95%CI: 0.64-0.90), P<0.01). There was 67% reduction in SCD among ICD therapy group (OR, 0.33(95%CI: 0.25-0.44), P<0.00001) compared to the control, a similar trend was observed in both ischemic (OR, 0.39(95%CI: 0.28-0.56), P<0.00001), and nonischemic cardiomyopathy (OR, 0.24(95%CI: 0.15-0.38), P<0.00001). The ICD therapy group had a significant reduction of 65% reduction in arrhythmia-related death compared to control in ischemic cardiomyopathy (OR, 0.35(95%CI: 0.19-0.64), P<0.001). However, there was a trend of 23% in cardiovascular mortality in the ICD group (OR, 0.77(95%CI: 0.58-1.02), P=0.07) but unable to reach statistical significance. Conclusion: Overall, primary prevention with ICD therapy reduced the incidence of all-cause mortality and sudden cardiac death among ischemic and nonischemic cardiomyopathy patients.