Clinical Course and Implantable Cardioverter Defibrillator Therapy in Postinfarction Women with Severe Left Ventricular Dysfunction

Authors


  • This study was supported by a research grant from Guidant Corporation, St. Paul, MN to the University of Rochester School of Medicine and Dentistry.

  • Manuscript received 21 December 2004; Revised manuscript received 8 April 2005; Accepted for publication 13 April 2005.

Wojciech Zareba, M.D., Ph.D., Heart Research Follow-up Program, Box 653, University of Rochester Medical Center, Rochester, NY 14642-8653. Fax: 585-273-5283; E-mail: wojciech_zareba@urmc.rochester.edu

Abstract

Background: There are limited data regarding implantable cardioverter defibrillator (ICD) therapy in postinfarction women with severe left ventricular dysfunction. The aim of this study was to evaluate the risk of cardiac events and effects of ICD therapy in women as compared to men enrolled in the Multicenter Automatic Defibrillator Implantation Trial II (MADIT II).

Methods and Results: Among 1,232 patients enrolled in MADIT II, there were 192 (16%) women and 1,040 (84%) men. When compared to men, women had an increased frequency of NYHA class ≥II (70 vs 63%; P = 0.067), hypertension (60% vs 52%; P = 0.047), diabetes (42% vs 34%; P = 0.027), and LBBB (25% vs 17%; P = 0.011), and less frequent CABG surgery (42% vs 60%; P < 0.001). The 2-year cumulative mortality in patients randomized to conventional therapy was not significantly different in women and men (30% and 20%, respectively; P = 0.19). Adjusting for relevant clinical covariates, the hazard ratios for ICD effectiveness were similar in women (0.57; 95% CI = 0.28–1.18; P = 0.132) and men (0.66; 95% CI = 0.48–0.91; P = 0.011). The risk of appropriate ICD therapy for VT/VF was lower in women than in men (hazard ratio = 0.60 for female vs male gender; 95% CI = 0.37–0.98; P = 0.039).

Conclusions: MADIT II women had similar mortality and similar ICD effectiveness when compared to men. MADIT II women with ICDs had a lower risk of arrhythmic events with fewer episodes of ventricular tachycardia than men.

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