MADIT-I

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Moss, AJ et al. "Improved Survival with an Implanted Defibrillator in Patients with Coronary Disease at High Risk for Ventricular Arrhythmia" New England Journal of Medicine. 335(26), 1933–1940.

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Clinical Question

In high-risk patients with ischemic cardiomyopathy does prophylactic ICD placement improve survival?

Bottom Line

In post-MI patients with systolic dysfunction (EF <35%), asymptomatic NSVT, and inducible non-suppressible ventricular tachyarrhythmia on electrophysiology study, prophylactic ICD reduced mortality compared to standard medical therapy.

Major Points

Guidelines

AHA/ACC/HRS Ventricular Arrhythmia and Prevention of Sudden Cardiac Death Guidelines (2017, adapted) [1]

  • ICD is recommended in patients with prior MI, NSVT, LVEF of 40% or less, and inducible sustained VT or VF at EP study if meaningful survival of greater than 1 year is expected (Class I: LOE B-R)

Design

Population

Inclusion Criteria

Exclusion Criteria

Baseline Characteristics

Baseline Therapy

Interventions

Outcomes

Primary Outcome

Outcome

Secondary Outcome

Outcome

Subgroup Analysis

Criticisms

Funding

  • CPI/Guidant Corporation, St. Paul, Minn.

Further Reading