Abstract
BackgroundThe Nippon Storm Study was a prospective observational study designed to gather clinical data on implantable cardioverter-defibrillator (ICD) therapy in Japanese patients.ObjectiveThe purpose of this subanalysis was to compare the incidence of ICD therapy in patients with left ventricular dysfunction owing to coronary artery disease (CAD) for primary and secondary prophylaxis of sudden cardiac death.MethodsWe analyzed data of 493 patients with CAD and ICDs (men, 87%; age, 68 ± 10 years; left ventricular ejection fraction, 36% ± 13%; primary prophylaxis, 36%). All patients were followed up for at least 2 years. Propensity score matching was used to select patient subgroups for comparison: 133 patients with ICD for primary prophylaxis and 133 with ICD for secondary indications.ResultsThere were no significant differences between primary and secondary prophylaxis groups with respect to the incidence of appropriate ICD therapy within 2 years (0.153 vs 0.239; hazard ratio, 1.565 [95% confidence interval (CI), 0.898–2.727]; P = .114). Two-year electrical storm risks were 3.3% and 9.6% with HR = 3.236 (95% CI, 1.058–9.896; P = .039) in patients with primary and secondary prophylaxis, respectively.ConclusionThe incidence of ICD therapy received by patients with CAD for primary and secondary prophylaxis was not significantly different based on our propensity score–matched analysis. However, secondary-prophylaxis ICD therapy seems to be associated with a significantly higher risk for electrical storm than primary-prophylaxis ICD therapy.
Highlights
Treatment with implantable cardioverter-defibrillators (ICDs) is used worldwide to prevent sudden cardiac death (SCD) in patients with ischemic cardiomyopathy who are at risk of fatal arrhythmic events.[1,2,3] there have been no large-scale studies on prophylactic ICD therapy in Japan
We focused on 493 patients with coronary artery disease (CAD) out of 1274 patients who had structural heart disease
The baseline characteristics considered for propensity score calculation, except for class III antiarrhythmic drugs treatment, were almost distributed between the 2 study groups
Summary
Treatment with implantable cardioverter-defibrillators (ICDs) is used worldwide to prevent sudden cardiac death (SCD) in patients with ischemic cardiomyopathy who are at risk of fatal arrhythmic events.[1,2,3] there have been no large-scale studies on prophylactic ICD therapy in Japan. Improvements in revascularization techniques, such as percutaneous coronary intervention (PCI) and coronary artery bypass grafts, have contributed to decreased cardiovascular mortality in patients with coronary artery disease (CAD) over the past few decades.[4,5] The Nippon Storm Study was a prospective observational study designed to gather clinical data from Japanese patients receiving ICD therapy.[6,7] In total, 1570 patients were enrolled at 48 ICD centers in Japan. The Nippon Storm Study was a prospective observational study designed to gather clinical data on implantable cardioverter-defibrillator (ICD) therapy in Japanese patients
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