Document Detail


Predictors of long-term mortality in Multicenter Automatic Defibrillator Implantation Trial II (MADIT II) patients with implantable cardioverter-defibrillators.
MedLine Citation:
PMID:  19324304     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Data on long-term follow-up and factors influencing mortality in implantable cardioverter-defibrillator (ICD) recipients are limited. OBJECTIVE: The aim of this study was to evaluate mortality during long-term follow-up and the predictive value of several risk markers in the Multicenter Automatic Defibrillator Implantation Trial II (MADIT II) patients with implanted cardioverter-defibrillators (ICDs). METHODS: The study involved U.S. patients from the MADIT II trial randomized to and receiving ICD treatment. Data regarding long-term mortality were retrieved from the National Death Registry. Several clinical, biochemical, and electrocardiogram variables were tested in a multivariate Cox model for predicting long-term mortality, and a score identifying high-, medium-, and lower risk patients was developed. RESULTS: The study population consisted of 655 patients, mean age 64 +/- 10 years. During a follow-up of up to 9 years, averaging 63 months, 294 deaths occurred. The 6-year cumulative probability of death was 40%, with evidence of a constant risk of about 8.5% per year among survivors. Median survival was estimated at 8 years. Multivariate analysis identified age >65 years, New York Heart Association class 3-4, diabetes, non-sinus rhythm, and increased levels of blood urea nitrogen as independent risk predictors of mortality. Patients with three or more of these risk factors were characterized by a 6-year mortality rate of 68%, compared with 43% in those with one to two risk factors and 19% in patients with no risk factors. CONCLUSION: A combination of a few readily available clinical variables indicating advanced disease and comorbid conditions identifies ICD patients at high risk of mortality during long-term follow-up.
Authors:
Iwona Cygankiewicz; John Gillespie; Wojciech Zareba; Mary W Brown; Ilan Goldenberg; Helmut Klein; Scott McNitt; Slava Polonsky; Mark Andrews; Edward M Dwyer; W Jackson Hall; Arthur J Moss;
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Publication Detail:
Type:  Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't     Date:  2008-12-24
Journal Detail:
Title:  Heart rhythm : the official journal of the Heart Rhythm Society     Volume:  6     ISSN:  1556-3871     ISO Abbreviation:  Heart Rhythm     Publication Date:  2009 Apr 
Date Detail:
Created Date:  2009-03-27     Completed Date:  2009-07-07     Revised Date:  2009-10-27    
Medline Journal Info:
Nlm Unique ID:  101200317     Medline TA:  Heart Rhythm     Country:  United States    
Other Details:
Languages:  eng     Pagination:  468-73     Citation Subset:  IM    
Affiliation:
Cardiology Division, University of Rochester Medical Center, Rochester, New York 14642, USA. iwona.cygankiewicz@heart.rochester.edu
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MeSH Terms
Descriptor/Qualifier:
Biological Markers / blood
Chi-Square Distribution
Defibrillators, Implantable*
Electrocardiography
Female
Follow-Up Studies
Humans
Male
Middle Aged
Myocardial Infarction / mortality*,  therapy*
Predictive Value of Tests
Probability
Proportional Hazards Models
Risk Factors
Treatment Outcome
United States / epidemiology
Ventricular Dysfunction, Left / mortality*,  therapy*
Chemical
Reg. No./Substance:
0/Biological Markers

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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