Arrhythmias & electrophysiologyMeta-analysis
Sudden cardiac death risk after myocardial infarction across the spectrum of left ventricular ejection fraction: a meta-analysis
- meta-analysis
- random-effects model
- PRISMA guidelines
Authors' conclusion
This is the first meta-analysis reviewing post-MI patients with LVEF 36-50%. These findings highlight a clinically relevant unmet need for patients who carry a substantial burden of SCD despite being outside current ICD eligibility criteria. Further study is needed to improve risk stratification within this population and determine whether suitable intervention is beneficial.
Study context
- Population
- Patients post-MI with left ventricular ejection fraction (LVEF) 36–50% without additional risk stratification or interventionpatients in five included studies (7435 records identified)
- Participants
- 9,345 participants
- Comparison
- Annual rate of sudden cardiac death (SCD) in patients with LVEF 36-50% post-MI vs LVEF≤35% and LVEF >50%
Pooled result
As reported in the abstract
LVEF≤35% vs LVEF 36-50%: P = 0.03 · LVEF >50% vs LVEF 36-50%: P = 0.02
Further pooled results
Proportion of mortality due to SCD
- Similar across all LVEF strata
- P = 0.79
Between-study heterogeneity
- I 2 for SCD
- 89.9%
- I 2 for all-cause mortality
- 96.8%
- Very high between-study heterogeneity
Primary prevention implantable cardioverter defibrillator (ICD) NNT for patients with LVEF 36-50% · 5-year device lifespan (extrapolation)
- NNT
- 19
- exploratory modelling
- applying the MADIT-II ICD treatment effect (HR 0.33, 95% CI 0.20 to 0.53)
Original publication
Summarised from the published abstract; every number is checked against it