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Primary Prevention of Sudden Cardiac Death with Implantable Cardioverter Defibrillators: Lessons Learned From MADIT and MUSTT
Author(s) -
GOLD MICHAEL R.,
NISAM SEAH
Publication year - 2000
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/j.1540-8159.2000.tb07067.x
Subject(s) - medicine , cardiology , myocardial infarction , population , ventricular tachycardia , implantable cardioverter defibrillator , sudden cardiac death , environmental health
The MADIT study lead to the first approved prophylactic indication for ICDs in patients with previous myocardial infarction, depressed left ventricular systolic function, nonsustained ventricular tachycardia (VT), and inducible sustained VT. However, criticisms have been raised with respect to the study design and patient selection. The MUSTT yielded similar results (51 % lower mortality by ICD vs no antiarrhythmic drugs) in a comparable population. The results of MUSTT address the major criticisms of MADIT: (1) MADIT was a “small” study (n = 196), while MUSTT randomized 704 patients. (2) MADIT had an “imbalance” in its prescription of β‐blockers, whereas the “imbalance” favored the control group in MUSTT: (51% vs 34%). (3) MADIT had no untreated limb, but MUSTT did. (4) MADIT's control group mortality (32% at 2 years) was considered by some as “unrealistically high “, yet MUSTT measured a similar rate (28 % at 2 years). (5) MADIT presented no information relative to patients without inducible arrhythmias, but MUSTT recorded their outcomes in a registry. In conclusion, the combined results of MADIT and MUSTT confirm the appropriateness of their risk stratification schemes and the survival benefits of ICD therapy as a highly effective primary prevention in this high risk population.