The MADIT-ICD benefit risk score for Japanese patients -from Nippon Storm study-

Abstract Background Implantable cardioverter-defibrillators (ICDs) play a crucial role in preventing sudden death due to lethal arrhythmias such as ventricular tachycardia and ventricular fibrillation. However, like any medical intervention, ICD implantation is not without its complications. It is essential to carefully consider the risks and benefits, and appropriately stratify the risk of sudden death in order to make informed decisions. In 2020, the MADIT-ICD benefit risk score was proposed to utilize personalized integrated assessment of the competing risk of lethal arrhythmias vs. non-arrhythmic mortality in implantable cardioverter-defibrillator (ICD) candidates. Purpose To evaluate the risk stratification of using the MADIT-ICD benefit risk score in Japanese patients. Methods We analyzed the data of 451 patients, enrolled in the Nippon Storm Study, with left ventricular ejection fraction (LVEF) ≤35% who underwent ICD implantation for primary prophylaxis of sudden cardiac death (men, 78%; age, 65±12 years; LVEF, 25±6.4%; cardiac resynchronization therapy, 73%; ischemic cardiomyopathy (ICM), 33%). Results A total of 336 patients were enrolled iln this study. The MADIT-ICD benefit risk scores, except systolic blood pressure, was calculated (Figure 1). These patients were classified into 3 groups (Lowest, Intermediate, Highest). There were no significant differences between the three groups in all-cause mortality, cardiovascular death, non-arrhythmic death, and appropriate ICD therapy (Figure 2). The multivariate analysis demonstrated that LVEF ≤25% was significantly associated with all-cause mortality, cardiovascular death, non-arrhythmic death (p=0.0487, 0.0150, 0.0387). Conclusion The MADIT-ICD benefit risk score may not be appropriate to risk stratification in Japanese patients using ICD for primary prophylaxis.Figure 1Figure 2