Survival benefit of the implantable cardioverter-defibrillator in patients on the waiting list for cardiac transplantation

The implantable cardioverter-defibrillator (ICD) effectively reduces sudden cardiac death in patients with severe LV dysfunction. Effect of ICD therapy on total mortality in patients on the waiting list for cardiac transplantation is still uncertain. We retrospectively analyzed 854 unselected consec...

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Bibliographic Details
Published in:Circulation (New York, N.Y.) N.Y.), 2001-09, Vol.104 (12 Suppl 1), p.I171-I176
Main Authors: Sandner, S E, Wieselthaler, G, Zuckermann, A, Taghavi, S, Schmidinger, H, Pacher, R, Ploner, M, Laufer, G, Wolner, E, Grimm, M
Format: Article
Language:English
Subjects:
Comorbidity
Death, Sudden, Cardiac - epidemiology
Death, Sudden, Cardiac - prevention & control
Defibrillators, Implantable - statistics & numerical data
Female
Follow-Up Studies
Heart Transplantation
Humans
Male
Middle Aged
Multivariate Analysis
Predictive Value of Tests
Proportional Hazards Models
Retrospective Studies
Survival Analysis
Survival Rate
Treatment Outcome
Ventricular Dysfunction, Left - mortality
Ventricular Dysfunction, Left - therapy
Waiting Lists
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Summary:The implantable cardioverter-defibrillator (ICD) effectively reduces sudden cardiac death in patients with severe LV dysfunction. Effect of ICD therapy on total mortality in patients on the waiting list for cardiac transplantation is still uncertain. We retrospectively analyzed 854 unselected consecutive patients (ICD therapy, n=102; 11.9%) on the waiting list for cardiac transplantation between January 1992 and March 2000. Actuarial 12-month total mortality rate on the waiting list was 24.2%; sudden cardiac death was the predominant mode of death (66.7% of total deaths). Kaplan-Meier analysis revealed improved survival for ICD (total mortality, 13.2%) compared with non-ICD (total mortality, 25.8%) patients (log rank, P=0.03). No event of sudden death occurred in ICD patients, whereas in non-ICD patients, 12-month sudden death rate was 20.1% (P=0.0001). Nonsudden death rates did not differ between ICD and non-ICD patients (P=0.16). A Cox proportional hazards model demonstrated that absence of an ICD was a powerful independent predictor of total mortality (P=0.02; relative risk, 2.22; 95% confidence interval, 1.16 to 4.17) and sudden cardiac death (P
ISSN:0009-7322
1524-4539
DOI:10.1161/circ.104.suppl_1.I-171