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Publications

Journal Article Ahead of print

PubMed: 42663237 DOI: 10.1093/eurheartj/ehag706

Mortality reduction with implanted defibrillator for primary prevention of sudden death after Myocardial Infarction: temporal trends in the PROFID study.

Eur Heart J

Authors: Alireza Sepehri Shamloo, Toshinori Chiba, Jan G P Tijssen, Till Althof, Serge Boveda, Frieder Braunschweig, Christian de Chillou, Jonas Faxén, Tim Friede, Laura Fusini, Chris P Gale, Robert Hättasch, Felix Hohendanner, Juhani Junttila, Thomas Kaas, Zoher Kapacee, Antti Kiviniemi, Valentina Kutyifa, Christophe Leclercq, Radosław Lenarczyk, Francisco Leyva, Michael Maeng, Eloi Marijon, Jose Luis Merino, Lluis Mont, Jens Cosedis Nielsen, Kevin Kris Warnakula Olesen, Gianluca Pontone, Helmut Pürerfellner, Georg Schmidt, Peter J Schwartz, Christian Sticherling, Mahmoud Suleiman, Hanno L Tan, Jacob Tfelt-Hansen, Holger Thiele, Verena Tscholl, Tom Verstraelen, Arthur Wilde, Katherine C Wu, Markus Zabel, Gerhard Hindricks, Nikolaos Dagres

Affiliations

  • Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité (DHZC), Berlin, Germany.
  • Charité - Universitätsmedizin Berlin, Germany.
  • Department of Cardiology, Amsterdam University Medical Centre, Amsterdam, The Netherlands.
  • Clinique Pasteur, Toulouse, France.
  • Heart Center, Karolinska University Hospital, Stockholm, Sweden.
  • Department of Cardiology, University Hospital Nancy, Nancy, France.
  • Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden.
  • Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.
  • Department of Medical Statistics, University Medical Center Göttingen, Göttingen, Germany.
  • DZHK (German Center for Cardiovascular Research), Partner Site Göttingen, Göttingen, Germany.
  • Centro Cardiologico Monzino IRCCS, Milan, Italy.
  • Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom.
  • Leeds Institute for Data Analytics, University of Leeds, Leeds, United Kingdom.
  • Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom.
  • Research Unit of Biomedicine and Internal Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.
  • Umbizo Limited, Manchester, United Kingdom.
  • University of Oulu and Oulu University Hospital, Oulu, Finland.
  • University of Rochester Medical Center, Rochester, NY, USA.
  • CHU Pontchaillou, Rennes, France.
  • Department of Cardiology, Silesian Center for Heart Diseases, Medical University of Silesia, Katowice, DMS in Zabrze, Poland.
  • Aston Medical School, Aston University, Aston Triangle, Birmingham, United Kingdom.
  • Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
  • Division of Cardiology, European Georges Pompidou Hospital, Paris, France.
  • La Paz University Hospital, Madrid, Memorial Publio Cordon Hospital, Pozuelo Alarcon, Spain.
  • Hospital Clínic, University of Barcelona, Barcelona, Spain.
  • Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy.
  • Department of Cardiology, Angiology and Intensive Care Medicine, Ordensklinikum Linz Elisabethinen, Linz, Austria.
  • Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
  • Center for Cardiac Arrhythmias of Genetic Origin, Istituto Auxologico Italiano IRCCS, Milan, Italy.
  • Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland.
  • Rambam Health Care Campus, Haifa, Israel.
  • Department of Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
  • Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
  • Section of Genetics, Department of Forensic Medicine, Faculty of Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
  • European Reference Network for rare, low prevalence and complex diseases of the heart: ERN GUARD-Heart (http://guardheart.ern-net.eu).
  • Department of Cardiology, Heart Center Leipzig at Leipzig University, Leipzig, Germany.
  • Amsterdam UMC location University of Amsterdam, Department of Cardiology, Amsterdam, The Netherlands.
  • Amsterdam Cardiovascular Sciences, Heart Failure and Arrhythmias, Amsterdam, The Netherlands.
  • Johns Hopkins University School of Medicine, Baltimore, MD, USA.
  • Department of Cardiology and Pneumology, Heart Center, University Medical Center Göttingen, Göttingen, Germany.

Abstract

BACKGROUND AND AIM

Randomized trials conducted in the early 2000s established the survival benefit of primary prevention implantable cardioverter-defibrillator (ICD) therapy in patients with reduced left ventricular ejection fraction (LVEF) after myocardial infarction. However, management of myocardial infarction and heart failure has substantially evolved since that time. We investigated whether the estimated association between primary prevention ICD implantation in post-myocardial infarction patients with reduced LVEF and mortality reduction has changed over time.

METHODS

We analyzed individual participant data from 32,214 patients with LVEF ≤35% after myocardial infarction included in the PROFID pooled cohort, comprising 7,477 patients carrying a primary prevention ICD (ICD patients) and 24,737 patients without an ICD (non-ICD patients). The primary endpoint was all-cause mortality. Propensity scores were estimated using multivariable logistic regression including age, sex, LVEF, renal function, and diabetes, and overlap weighting was applied to balance treatment groups. Time period-specific analyses were performed across three prespecified time periods defined by inclusion year: 1995-2004, 2005-2014, and 2015-2020. Weighted cumulative mortality curves were generated for each time period. Temporal changes in the estimated association between ICD implantation and mortality reduction were assessed using a weighted Cox proportional hazards model.

RESULTS

A total of 12,097 deaths occurred during a mean follow-up of 43.7 months. The estimated association between ICD implantation and mortality changed significantly across time (P for interaction <0.001). In weighted time period-specific analyses, the estimated mortality reduction associated with ICD implantation progressively decreased over more recent periods. The hazard ratio for ICD versus non-ICD patients was 0.54 (95% CI 0.47-0.62; P<0.001) in 1995-2004, 0.67 (95% CI 0.62-0.72; P<0.001) in 2005-2014, and 0.89 (95% CI 0.73-1.07; P=0.221) in 2015-2020, with negligible separation of the weighted cumulative mortality curves in the most recent time period.

CONCLUSIONS

In this analysis including a large cohort of post-myocardial infarction patients with reduced LVEF, the estimated mortality reduction associated with primary prevention ICD implantation progressively decreased over time.

MeSH

Death, Sudden, Mortality, Myocardial Infarction, Heart Failure, Primary Prevention, Therapeutics, Defibrillators