ICD心脏性猝死一级预防.pptVIP

* 225,000 to 300,000 of SCA patients in the U.S. have had a previous MI. * * The proportionate contribution of SCD to total mortality in HF associated with reduced left ventricular function has not changed substantially between the Framingham data and now. Kannel WB, Wilson PWF, DAgostino RB, Cobb J. Sudden coronary death in women. Am Heart J 1998 Aug; 136: 205-212 * * * * ICD therapy reduced overall mortality by 54% compared to conventional therapy (relative risk reduction). * 20 MUSTT was the next major primary prevention study that showed excellent results with ICD therapy. MUSTT was originally intended to compare EP-guided therapy (ICD or AAD) versus no antiarrhythmic therapy. On further analysis, the investigators found that ICD therapy was far superior to AAD drug therapy. The primary endpoint of MUSTT was arrhythmic mortality unlike all the other ICD trials which used overall mortality as the primary endpoint. The secondary endpoint in MUSTT was overall mortality. The entry criteria for MUSTT was similar to MADIT I: LVEF ? 40%, CAD, non-sustained VT, sustained VT on programmed electrical stimulation. Given the similar inclusion criteria, it is not surprising that the results of MUSTT were consistent with MADIT. After adjusting for covariates, MUSTT showed a 73% reduction in arrhythmic mortality and a 55% reduction in overall mortality in the ICD arm compared to patients taking no antiarrhythmic therapy. After the publishing of the MUSTT results, physician adoption of the MADIT indication increased significantly. This is not surprising given the consistent results and similar inclusion criteria of MADIT and MUSTT. * By examining the Kaplan-Meier survival curves, we note that the ICD benefit began after approximately one year. Importantly, as demonstrated by the widening of the curves over time, the ICD benefit appears to increase over time. In an important recent analysis, Dr. Moss announced that there was a 40% cumulative probability of appropriat