Chiba Toshinori, Kondo Yusuke, Shiko Yuki, Nakano Masahiro, Takatsugu Kajiyama, Nakano Miyo, Ito Ryo, Sugawara Masafumi, Yoshino Yutaka, Ryuzaki Satoko, Takanashi Yukiko, Komai Yuya, Kobayashi Yoshio
Department of Advanced Cardiorhythm Therapeutics, Chiba University Graduate School of Medicine, Chiba, Japan.
Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan.
ESC Heart Fail. 2025 Feb;12(1):369-378. doi: 10.1002/ehf2.15081. Epub 2024 Sep 20.
The MADIT-ICD benefit score is used to stratify the risk of life-threatening arrhythmia and non-arrhythmic mortality. We sought to develop an implantable cardioverter defibrillator (ICD) benefit-prediction score for Japanese patients with ICDs.
Patients who underwent ICD implantation as primary prophylaxis were retrospectively enrolled. Based on their MADIT-ICD benefit scores, we developed a modified MADIT-ICD benefit score adapted to the Japanese population. The primary endpoints were appropriate ICD therapy and all-cause death without appropriate ICD therapy (non-arrhythmic death). We used the Fine and Gray multivariate model and Cox proportional hazard regression to identify factors for adjusting the MADIT-ICD benefit-risk score specifically for the Japanese population. The scoring points for the original MADIT-ICD benefit score were adjusted to optimal points based on the multivariate analysis results in the population.
The study enrolled 167 patients [age, 61.9 ± 12.3 years; male individuals, 138 (82.6%); cardiac resynchronization therapy, 73 (43.7%); ischaemic cardiomyopathy, 53 (31.7%)]. Fourteen patients received anti-tachycardia pacing (ATP) therapy, and 23 received shock therapy as the initial appropriate ICD therapy. Non-arrhythmic deaths occurred in 37 patients. The original MADIT-ICD benefit score could not stratify non-arrhythmic mortality in the Japanese population. The patients were reclassified into three groups according to the modified MADIT-ICD benefit score. The modified MADIT-ICD benefit score could effectively stratify the incidence of appropriate ICD therapy and non-arrhythmic mortality. In the highest-benefit group, the 10 year cumulative rates of appropriate ICD therapy and non-arrhythmic mortality were 56.8% and 12.9%, respectively (P < 0.01). In the intermediate-benefit group, these rates were 20.2% and 40.2% (P = 0.01). In the lowest-benefit group, the incidence of non-arrhythmic deaths was 68.1%, and no patient received appropriate ICD therapy.
The modified MADIT-ICD benefit score may be useful for stratifying ICD candidates in the Japanese population.
MADIT-ICD获益评分用于对危及生命的心律失常和非心律失常性死亡风险进行分层。我们试图为日本植入式心律转复除颤器（ICD）患者开发一种ICD获益预测评分。
回顾性纳入接受ICD植入作为一级预防的患者。基于他们的MADIT-ICD获益评分，我们开发了一种适用于日本人群的改良MADIT-ICD获益评分。主要终点是适当的ICD治疗以及未进行适当ICD治疗的全因死亡（非心律失常性死亡）。我们使用Fine和Gray多变量模型以及Cox比例风险回归来确定专门针对日本人群调整MADIT-ICD获益风险评分的因素。根据人群中的多变量分析结果，将原始MADIT-ICD获益评分的得分点调整为最佳得分点。
该研究纳入了167例患者[年龄，61.9±12.3岁；男性，138例（82.6%）；心脏再同步治疗，73例（43.7%）；缺血性心肌病，53例（31.7%）]。14例患者接受了抗心动过速起搏（ATP）治疗，23例接受了电击治疗作为初始适当的ICD治疗。37例患者发生了非心律失常性死亡。原始MADIT-ICD获益评分无法对日本人群中的非心律失常性死亡率进行分层。根据改良的MADIT-ICD获益评分将患者重新分为三组。改良的MADIT-ICD获益评分可以有效地对适当ICD治疗的发生率和非心律失常性死亡率进行分层。在最高获益组中，适当ICD治疗和非心律失常性死亡的10年累积发生率分别为56.8%和12.9%（P<0.01）。在中等获益组中，这些发生率分别为20.2%和40.2%（P=0.01）。在最低获益组中，非心律失常性死亡的发生率为68.1%，没有患者接受适当的ICD治疗。
改良的MADIT-ICD获益评分可能有助于对日本人群中的ICD候选者进行分层。
