Abstract
Introduction:Ischemic cardiomyopathy (ICM) and idiopathic dilated cardiomyopathy
(DCM) share common structural alterations with a high mortality from
sudden cardiac death (SCD) and pump failure. Implantable
cardioverter-defibrillator (ICD) has, since inclusion in international
guidelines, been confirmed beneficial and cost-effective for primary
prevention of SCD in patients with ICM, while huge debates in
non-ischemic heart disease. This study was to compare the primary
prophylactic value of ICD therapy in patients with ICM or DCM to
identify a subgroup with greater advantage specially.
Methods: We conducted a
retrospective,
single-center study, which enrolled 82 patients with ICM or DCM and
guideline indications for primary prophylactic ICD or cardiac
resynchronization therapy-defibrillator (CRT-D). Primary end-point was
all-cause mortality and secondary outcomes included SCD and
cardiovascular death.
Results: During a median follow-up of 38.5 months, 78 patients
baseline data were
analyzable.
The primary outcome occurred in 8 patients in ICM group and 5 patients
in DCM group (p = 0.012). Cardiovascular death occurred in 5 patients in
ICM group and 3 patients in DCM group
[hazard
ratio (HR) 0.119, 95% confidence interval (CI) 0.016-0.860, P =
0.035]. Resuscitated cardiac arrest or sustained ventricular
tachycardia occurred in 4 patients in ICM group and 8 patients in DCM
group (HR 0.294, 95% CI 0.040-2.144, P = 0.227).
Conclusions: DCM patients with ICD implantation could gain more
benefit with a reduction in the risk of all-cause mortality and
cardiovascular disease compared with ICM patients, while the occurrence
of SCD had no difference in two groups.