Imperial College London

DrZacharyWhinnett

Faculty of MedicineNational Heart & Lung Institute

Reader in Cardiac Electrophysiology
 
 
 
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Contact

 

z.whinnett

 
 
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Location

 

South- NHLI Cardiovascular ScienceBlock B Hammersmith HospitalHammersmith Campus

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Summary

 

Publications

Citation

BibTex format

@article{Shun-Shin:2017:eurheartj/ehx028,
author = {Shun-Shin, MJ and Zheng, S and Cole, G and Howard, J and Whinnett, Z and Francis, D},
doi = {eurheartj/ehx028},
journal = {European Heart Journal},
pages = {1738--1746},
title = {Implantable cardioverter defibrillators for primary prevention of death in left ventricular dysfunction with and without ischaemic heart disease: a meta-analysis of 8567 patients in the 11 trials},
url = {http://dx.doi.org/10.1093/eurheartj/ehx028},
volume = {38},
year = {2017}
}

RIS format (EndNote, RefMan)

TY  - JOUR
AB - AimsPrimary prevention implantable cardioverter defibrillators (ICDs) are established therapy for reducing mortality in patients with left ventricular systolic dysfunction and ischaemic heart disease (IHD). However, their efficacy in patients without IHD has been controversial. We undertook a meta-analysis of the totality of the evidence.Methods We systematically identified all RCTs comparing ICD versus no ICD in primary prevention. Eligible RCTs were those that recruited patients with left ventricular dysfunction, reported all-cause mortality, and presented their results stratified by the presence of IHD (or recruited only those with or without). Our primary endpoint was all-cause mortality.ResultsWe identified 11 studies enrolling 8567 participants with left ventricular dysfunction, including 3128 patients without IHD and 5439 patients with IHD. In patients without IHD, ICD therapy reduced mortality by 24% (HR 0.76, 95% CI 0.64 to 0.90 p=0.001). In patients with IHD, ICD implantation (at a dedicated procedure), also reduced mortality by 24% (HR 0.76, 95% CI 0.60 to 0.96, p=0.02).ConclusionsUntil now, it has never been explicitly stated that the patients without IHD in COMPANION showed significant survival benefit from adding ICD therapy (to a background of CRT). Furthermore, even with only the trials before DANISH, meta-analysis shows reduced mortality. DANISH is consistent with these data.With a significant 24% mortality reduction in both aetiologies, it may no longer be necessaryto distinguish between them when deciding on primary prevention ICD implantation.
AU - Shun-Shin,MJ
AU - Zheng,S
AU - Cole,G
AU - Howard,J
AU - Whinnett,Z
AU - Francis,D
DO - eurheartj/ehx028
EP - 1746
PY - 2017///
SN - 1522-9645
SP - 1738
TI - Implantable cardioverter defibrillators for primary prevention of death in left ventricular dysfunction with and without ischaemic heart disease: a meta-analysis of 8567 patients in the 11 trials
T2 - European Heart Journal
UR - http://dx.doi.org/10.1093/eurheartj/ehx028
UR - http://hdl.handle.net/10044/1/43974
VL - 38
ER -