Abstract | AIMS: METHODS AND RESULTS: Individual patient data from the Antiarrhythmics vs Implantable Defibrillator (AVID) study, the Cardiac Arrest Study Hamburg (CASH) and the Canadian Implantable Defibrillator Study (CIDS) were merged into a master database according to a pre-specified protocol. Proportional hazard modelling of individual patient data was used to estimate hazard ratios and to investigate subgroup interactions. Fixed effect meta-analysis techniques were also used to evaluate treatment effects and to assess heterogeneity across studies. The classic fixed effects meta-analysis showed that the estimates of ICD benefit from the three studies were consistent with each other (P heterogeneity=0.306). It also showed a significant reduction in death from any cause with the ICD; with a summary hazard ratio (ICD: amiodarone) of 0.72 (95% confidence interval 0.60, 0.87;P=0.0006). For the outcome of arrhythmic death, the hazard ratio was 0.50 (95% confidence interval 0.37, 0.67;P<0.0001). Survival was extended by a mean of 4.4 months by the ICD over a follow-up period of 6 years. Patients with left ventricular ejection fraction < or = 35% derived significantly more benefit from ICD therapy than those with better preserved left ventricular function. Patients treated before the availability of non- thoracotomy ICD implants derived significantly less benefit from ICD therapy than those treated in the non- thoracotomy era. CONCLUSION: Results from the three trials of the ICD vs amiodarone are consistent with each other. There is a 28% reduction in the relative risk of death with the ICD that is due almost entirely to a 50% reduction in arrhythmic death.
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Authors | S J Connolly, A P Hallstrom, R Cappato, E B Schron, K H Kuck, D P Zipes, H L Greene, S Boczor, M Domanski, D Follmann, M Gent, R S Roberts |
Journal | European heart journal
(Eur Heart J)
Vol. 21
Issue 24
Pg. 2071-8
(Dec 2000)
ISSN: 0195-668X [Print] England |
PMID | 11102258
(Publication Type: Journal Article, Meta-Analysis)
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Copyright | Copyright 2000 The European Society of Cardiology. |
Chemical References |
- Anti-Arrhythmia Agents
- Amiodarone
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Topics |
- Amiodarone
(therapeutic use)
- Anti-Arrhythmia Agents
(therapeutic use)
- Death, Sudden, Cardiac
(etiology, prevention & control)
- Defibrillators, Implantable
- Humans
- Randomized Controlled Trials as Topic
- Risk
- Tachycardia, Ventricular
(complications, therapy)
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