Are MADIT II Criteria for Implantable Cardioverter Defibrillator Implantation Appropriate for Chinese Patients?

Authors

  • CHUNG-WAH SIU M.B.B.S.,

    1. Cardiology Division, Department of Medicine, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong
    2. Research Center of Heart, Brain, Hormone and Healthy Aging, University of Hong Kong, Hong Kong SAR, China
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      These authors contributed equally to this work.

  • VINCENT PONG M.B.B.S.,

    1. Cardiology Division, Department of Medicine, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong
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      These authors contributed equally to this work.

  • HEE-HWA HO M.B.B.S.,

    1. Cardiology Division, Department of Medicine, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong
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      These authors contributed equally to this work.

  • SHASHA LIU M.S.,

    1. Cardiology Division, Department of Medicine, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong
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  • CHU-PAK LAU M.D.,

    1. Cardiology Division, Department of Medicine, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong
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  • SHEUNG-WAI LI M.B.B.S.,

    1. Cardiology Division, Department of Medicine, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong
    2. Department of Medicine, Tung Wah Hospital, Hong Kong, China
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  • HUNG-FAT TSE M.D., Ph.D.

    1. Cardiology Division, Department of Medicine, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong
    2. Research Center of Heart, Brain, Hormone and Healthy Aging, University of Hong Kong, Hong Kong SAR, China
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  • No conflicts of interest were declared.

Address for correspondence: Hung-Fat Tse, M.D., Ph.D., Cardiology Division, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China. Fax: +852-2818-6304; E-mail: hftse@hkucc.hku.hk

Abstract

MADIT II Criteria for Implantable Cardioverter. Background: MADIT-II demonstrated that prophylactic implantation of an implantable cardioverter-defibrillator (ICD) device prevents sudden cardiac death (SCD) in patients with myocardial infarction (MI) and impaired left ventricular ejection fraction (LVEF). It remains unclear whether the MADIT-II criteria for ICD implantation are appropriate for Chinese patients.

Methods and Results: We compared the clinical characteristics and outcome for a cohort of consecutive Chinese patients who satisfied MADIT-II criteria for ICD implantation with the original published MADIT-II population. Seventy consecutive patients who satisfied MADIT-II criteria but did not undergo ICD implantation (age: 67 years, male: 77%) were studied. Their baseline demographics were comparable with the original MADIT-II cohort with the exception of a higher incidence of diabetes mellitus. After follow-up of 35 months, most deaths (78%) were due to cardiac causes (72% due to SCD). The 2-year SCD rate (10.0%) was comparable with that of the MADIT-II conventional group (12.1%), but higher than the MADIT-II defibrillator group (4.9%). Similarly, the 2-year non-SCD rate was 3.0%, also comparable with the MADIT-II conventional group (4.6%), but lower than the MADIT-II defibrillator group (7.0%). Cox regression analysis revealed that advance NYHA function class (Hazard Ratio [HR]: 3.5, 95% Confidence Interval [CI]: 1.48–8.24, P = 0.004) and the lack of statin therapy (HR: 3.7, 95%CI: 1.35–10.17, P = 0.011) were independent predictors for mortality in the MADIT-II eligible patients.

Conclusion: Chinese patients who satisfy MADIT-II criteria for ICD implantation are at similar risk of SCD and non-SCD as the original MADIT-II subjects. Implantation of an ICD in Chinese patients is appropriate. (J Cardiovasc Electrophysiol, Vol. 21, pp. 231–235, March 2010)

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