Predicted benefit of an implantable cardioverter-defibrillator: the MADIT-ICD benefit score

Author:

Younis Arwa1ORCID,Goldberger Jeffrey J2,Kutyifa Valentina1ORCID,Zareba Wojciech1,Polonsky Bronislava1,Klein Helmut1ORCID,Aktas Mehmet K1,Huang David1,Daubert James3ORCID,Estes Mark4,Cannom David5,McNitt Scott1,Stein Kenneth6,Goldenberg Ilan1

Affiliation:

1. Division of Cardiology, Department of Medicine, Clinical Cardiovascular Research Center, University of Rochester Medical Center, 265 Crittenden Blvd CU 420653, NY 14642, USA

2. Division of Cardiology, Miller School of Medicine, University of Miami, 1321 NW 14th St #510, Miami, FL 33125, USA

3. Division of Cardiology, Duke Medicine Circle Clinic 2F/2G, Durham, NC 27710, USA

4. Division of Cardiology, UPMC Heart and Vascular Institute 1350 Locust Street, Suite 100 Pittsburgh, PA 15219, USA

5. Division of Cardiology, Good Samaritan Hospital, 1245 Wilshire Blvd, Ste 703, Los Angeles, CA 90017, USA

6. Cardiac Rhythm Management, Boston Scientific Corp., 4100 Hamline Ave N, St Paul, MN 55101, USA

Abstract

Abstract Aims The benefit of prophylactic implantable cardioverter-defibrillator (ICD) is not uniform due to differences in the risk of life-threatening ventricular tachycardia (VT)/ventricular fibrillation (VF) and non-arrhythmic mortality. We aimed to develop an ICD benefit prediction score that integrates the competing risks. Methods and results The study population comprised all 4531 patients enrolled in the MADIT trials. Best-subsets Fine and Gray regression analysis was used to develop prognostic models for VT (≥200 b.p.m.)/VF vs. non-arrhythmic mortality (defined as death without prior sustained VT/VF). Eight predictors of VT/VF (male, age < 75 years, prior non-sustained VT, heart rate > 75 b.p.m., systolic blood pressure < 140 mmHg, ejection fraction ≤ 25%, myocardial infarction, and atrialarrhythmia) and 7 predictors of non-arrhythmic mortality (age ≥ 75 years, diabetes mellitus, body mass index < 23 kg/m2, ejection fraction ≤ 25%, New York Heart Association ≥II, ICD vs. cardiac resynchronization therapy with defibrillator, and atrial arrhythmia) were identified. The two scores were combined to create three MADIT-ICD benefit groups. In the highest benefit group, the 3-year predicted risk of VT/VF was three-fold higher than the risk of non-arrhythmic mortality (20% vs. 7%, P < 0.001). In the intermediate benefit group, the difference in the corresponding predicted risks was attenuated (15% vs. 9%, P < 0.01). In the lowest benefit group, the 3-year predicted risk of VT/VF was similar to the risk of non-arrhythmic mortality (11% vs. 12%, P = 0.41). A personalized ICD benefit score was developed based on the distribution of the two competing risks scores in the study population (https://is.gd/madit). Internal and external validation confirmed model stability. Conclusions We propose the novel MADIT-ICD benefit score that predicts the likelihood of prophylactic ICD benefit through personalized assessment of the risk of VT/VF weighed against the risk of non-arrhythmic mortality.

Funder

University of Rochester

National Heart, Lung, and Blood Institute

Publisher

Oxford University Press (OUP)

Subject

Cardiology and Cardiovascular Medicine

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