부산대학교 도서관

Introduction: Guidelines recommend use of implantable cardioverter defibrillator (ICD) in all patients with non-ischemic cardiomyopathy (NICM) and ejection fraction (EF) < 35% for primary prevention of sudden cardiac death (SCD) and hence reduction of overall mortality. Contemporary randomized clinical trials (RCTs) with longer follow up duration have thrown into question this beneficial effect of ICDs.Hypothesis: Prophylactic use of ICDs in addition to optimal medical therapy (OMT) does not reduce adverse outcomes in patients with NICM and EF < 35% compared to OMT alone.Methods: Six RCTs (n=4541) comparing ICD + OMT vs OMT alone were selected from MEDLINE and EMBASE databases from inception through March 2022. Meta-analysis was performed using random effects model. Meta-regression analysis was performed with inverse-variance weighting and Knapp and Hartung adjustments for all-cause mortality.Results: ICDs did not reduce risk of all-cause mortality (Relative Risk (RR) 0.87, [95% confidence interval, 0.75-1.00], cardiovascular mortality (RR, 0.80 [0.49-1.31]), non-cardiovascular mortality (RR, 0.66 [0.13-3.34]) or non-sudden cardiac death (RR, 1.03 [0.51-2.08]). ICDs reduced the risk of sudden cardiac death (HR, 0.49 [0.26-0.92]). Meta-regression analysis did not show any association between all-cause mortality and follow up duration (p=0.09).Conclusions: ICDs reduce risk of SCD however this does not translate into meaningful improvement in long term cardiovascular outcomes.