Risk Stratification for Primary Implantation of a Cardioverter-Defibrillator in Patients With Ischemic Left Ventricular Dysfunction
Ilan Goldenberg, MD*,1,*,
Anant K. Vyas, MD, MPH ,1,
W. Jackson Hall, PhD ,1,
Arthur J. Moss, MD*,
Hongyue Wang, PhD,
Hua He, MA,
Wojciech Zareba, MD, PhD*,
Scott McNitt, MS*,
Mark L. Andrews, BBA* for the MADIT-II Investigators
* Cardiology Unit of the Department of Medicine, University of Rochester Medical Center, Rochester, New York
Department of Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester, New York
Cardiovascular Division of the Department of Medicine, University of Buffalo, Buffalo, New York.
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Figure 1 Probability of Survival in VHR Patients
Kaplan-Meier estimates of the probability of survival, by treatment group, in very high-risk (VHR) patients. CONV = conventional therapy group; ICD = implantable cardioverter-defibrillator.
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Figure 2 Probability of Survival in Patients With Risk Scores 0 and  1
Kaplan-Meier estimates of the probability of survival, by treatment group, in (A) patients with risk score = 0; and (B) patients with risk score 1. Analysis was conducted after omitting VHR group; in addition, 22 conventional and 19 ICD patients were omitted due to missing information on risk factors. Abbreviations as in Figure 1.
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Figure 3 Probability of Survival in Patients With Risk Scores 1, 2, and 3
Kaplan-Meier estimates of the probability of survival, by treatment group, in (A) patients with risk score = 1; (B) patients with risk score = 2; and (C) patients with risk score 3. Analysis was conducted after omitting VHR group; in addition, 22 conventional and 19 ICD patients were omitted because missing information on risk factors. Abbreviations as in Figure 1.
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Figure 4 U-Shaped Curve for ICD Efficacy
(A) Two-year Kaplan-Meier mortality rates in the ICD and conventional therapy groups; and (B) the corresponding 2-year mortality rate reduction with an ICD, by risk score and in VHR patients. *p < 0.05 for the comparison between the conventional therapy and ICD groups. Abbreviations as in Figure 1.
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Figure 5 Mode of Death by Risk Group
Percent of sudden cardiac deaths (SCD) and nonsudden deaths (e.g., all other modes of all-cause mortality) presented as the number of deaths per number of patients in each risk category, in (A) the conventional therapy group and (B) the ICD group. The mode of death was not determined in 28 (15%) cases that were distributed similarly among risk groups and omitted. Abbreviations as in Figure 1.
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