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Optimizing ICD Role in Primary Prevention of Sudden Cardiac Death – Does MADIT-ICD Benefit Score Helps in a Real-World Setting?
Session:
Posters (Sessão 3 - Écran 4) - Morte súbita cardíaca
Speaker:
Fabiana Duarte
Congress:
CPC 2023
Topic:
C. Arrhythmias and Device Therapy
Theme:
08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
Subtheme:
08.7 Ventricular Arrhythmias and SCD - Other
Session Type:
Pósters Electrónicos
FP Number:
---
Authors:
Fabiana Silva Duarte; Inês Coutinho Dos Santos; M. Inês Barradas; André Viveiros Monteiro; Raquel Dourado; Dinis Martins
Abstract
<p>Introduction: Decision-making in primary prevention can be challenging and many clinical scenarios are not reflected in current guidelines. To help evaluate a patient's individual risk, a new score to predict the benefit of an implantable defibrillator (ICD) for primary prevention, the MADIT-ICD benefit score, has recently been proposed.</p> <p>Objective: To evaluate MADIT-ICD benefit score accuracy in real-world patients with both non-ischemic and ischemic cardiomyopathy (ICM) and to compare this with selection based on multidisciplinary expert center approach.</p> <p>Methods: Patients with a primary preventive indication for ICD implantation from our center were included in the analysis and grouped according with the MADIT-ICD benefit score. Endpoints were (i) sustained ventricular tachycardia (VT) or ventricular fibrillation (VF) and (ii) non-arrhythmic mortality.</p> <p>Results: Of the 100 ICD patients included (mean age 60.5 ± 10.8 years, males 83%), subcutaneous ICD were implanted in 20%. Patients were stratified as low (13%), intermediate (43%) and high risk (44%) groups, according to the MADIT-ICD score. Ischemic cardiomyopathy (ICM) was more prevalent in the highest group (70.5% vs 50% vs 9.1%, p=0.001). No other differences in baseline characteristics were observed.<br /> During a mean follow-up of 3.7± 3.4 years, 14 patients developed sustained ventricular arrhythmias (7.1% in both high and intermediate risk groups, no one in the low-risk group, p=0.356), while 10 patients died for non-arrhythmic reasons (3.1% in the highest group, 6.1% in the intermediate group and 1% in the lowest group, p=0.542).<br /> The occurrence of ventricular arrhythmias could not sufficiently be predicted by the MADIT-ICD score in ICM patients. Of the risk factors included in the risk score calculation, only lower baseline left ventricular ejection fraction was significantly associated with sustained ventricular arrhythmias (p=0.028; AUC 0.701, 95% CI 0.56-0.85). Age was a key predictor of non-arrhythmic death (p<0.001; OR 0.27, 95% CI 0.05-1.46).<br /> MADIT-ICD score had low predictive power for both arrhythmic events (r2=0.1) and non-arrhythmic mortality (r2=0.05). Though, on subgroup analysis this score effectively predicted non-arrhythmic mortality (p <0.001, r=0.3) in ICM patients.</p> <p>Conclusion: On our patient’s cohort with primary-prevention implanted ICD, the value of MADIT-ICD score was limited to ICM patients. It might be worth to evaluate its accuracy for clinical decision-making in other subgroups as well.</p>
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