Block M, Breithardt G
Stiftsklinik Augustinum München.
Am J Cardiol. 1999 Mar 11;83(5B):74D-78D. doi: 10.1016/s0002-9149(98)01028-5.
The Multicenter Automatic Defibrillator Implantation Trial (MADIT) and the Coronary Artery Bypass Graft (CABG)-Patch study were the first 2 randomized trials investigating the usefulness of the implanted cardioverter defibrillator (ICD) for primary prevention of sudden death. Patients enrolled in MADIT and CABG-Patch had never experienced a sustained ventricular tachycardia (VT) but were thought to be at high risk of sudden death. All patients had coronary artery disease and severely suppressed left ventricular ejection fraction. CABG-Patch patients received their ICD during CABG surgery. Most MADIT patients already had received CABG or percutaneous transluminal coronary angiography and had no indication for revascularization procedures at study entry. MADIT patients had nonsustained spontaneous VT and inducible, nonsuppressible VT; CABG-Patch patients had only an abnormal signal-averaged electrocardiogram as an indicator of their arrhythmic risk. CABG-Patch patients did not benefit from ICD implantation, presumably due to the influence of revascularization on ischemia and left ventricular function. In contrast, MADIT patients showed an improved survival by the ICD. MADIT patients had no need for revascularization and, presumably, their risk indicator for arrhythmic events was stronger than the one used in CABG-Patch. MADIT criteria have become a class I indication for ICD implantation and, in the absence of testing for suppressibility of induced VTs, a class IIb criterion for ICD implantation. Screening for MADIT patients is expensive, as only relatively few patients after myocardial infarction fulfill the criteria. Nevertheless, in comparison with amiodarone, treatment of MADIT patients with ICDs seems to be cost-effective, especially if ICDs are implanted transvenously and have the improved battery longevity of the current devices.
多中心自动除颤器植入试验（MADIT）和冠状动脉旁路移植术（CABG）-贴片研究是最早的两项随机试验，旨在研究植入式心脏复律除颤器（ICD）用于心脏性猝死一级预防的有效性。参加MADIT和CABG-贴片研究的患者从未经历过持续性室性心动过速（VT），但被认为有心脏性猝死的高风险。所有患者均患有冠状动脉疾病且左心室射血分数严重降低。CABG-贴片研究的患者在冠状动脉旁路移植术手术期间植入ICD。大多数MADIT研究的患者已经接受过冠状动脉旁路移植术或经皮冠状动脉腔内血管成形术，在研究入组时没有血管重建手术的指征。MADIT研究的患者有非持续性自发性室性心动过速和可诱导的、不可抑制的室性心动过速；CABG-贴片研究的患者仅有异常信号平均心电图作为其心律失常风险的指标。CABG-贴片研究的患者未从ICD植入中获益，推测是由于血管重建对缺血和左心室功能的影响。相比之下，MADIT研究的患者通过植入ICD显示生存率有所提高。MADIT研究的患者不需要进行血管重建，并且推测他们的心律失常事件风险指标比CABG-贴片研究中使用的更强。MADIT标准已成为ICD植入的I类指征，并且在没有对诱导性室性心动过速的可抑制性进行检测的情况下，成为ICD植入的IIb类指征。对MADIT研究患者进行筛查成本高昂，因为心肌梗死后只有相对较少的患者符合标准。然而，与胺碘酮相比，用ICD治疗MADIT研究的患者似乎具有成本效益，特别是如果经静脉植入ICD且当前设备的电池寿命有所改善。
