Implications of the Multicenter Automatic Defibrillator Implantation Trial-II
Authors: Sana M. Al-Khatib, Daniel B. Mark, Robert M. Califf
Journal: Annals of Internal Medicine (2006)

Letters3 January 2006Implications of the Multicenter Automatic Defibrillator Implantation Trial-IISana M. Al-Khatib, MD, MHS, Daniel B. Mark, MD, and Robert M. Califf, MDSana M. Al-Khatib, MD, MHSFrom Duke University Clinical Research Institute, Durham, NC 27710.Search for more papers by this author, Daniel B. Mark, MDFrom Duke University Clinical Research Institute, Durham, NC 27710.Search for more papers by this author, and Robert M. Califf, MDFrom Duke University Clinical Research Institute, Durham, NC 27710.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-144-1-200601030-00017 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail IN RESPONSE:Dr. Weintraub argues that eplerenone, an aldosterone blocker, is more cost-effective than the ICD. Although his estimated incremental cost-effectiveness ratio of $10 402 per life-year gained for eplerenone seems much more favorable than our base-case ratio of $50 500 per life-year gained for an ICD, we caution against these comparisons when the interventions are not compared head-to-head. Both MADIT-II and EPHESUS enrolled appreciably different patients. Whereas all patients in EPHESUS had clinical or radiographic evidence of heart failure, half of the patients in MADIT-II did not. All patients in EPHESUS were enrolled 3 to 14 days after MI, but 88% ...References1. Moss AJ, Zareba W, Hall WJ, Klein H, Wilber DJ, Cannom DS, et al. Prophylactic implantation of a defibrillator in patients with myocardial infarction and reduced ejection fraction. N Engl J Med. 2002;346:877-83. [PMID: 11907286] CrossrefMedlineGoogle Scholar2. Pitt B, Remme W, Zannad F, Neaton J, Martinez F, Roniker B, et al. Eplerenone, a selective aldosterone blocker, in patients with left ventricular dysfunction after myocardial infarction. N Engl J Med. 2003;348:1309-21. [PMID: 12668699] CrossrefMedlineGoogle Scholar3. Hohnloser SH, Kuck KH, Dorian P, Roberts RS, Hampton JR, Hatala R, et al. Prophylactic use of an implantable cardioverter-defibrillator after acute myocardial infarction. N Engl J Med. 2004;351:2481-8. [PMID: 15590950] CrossrefMedlineGoogle Scholar4. Solomon SD, Zelenkofske S, McMurray JJ, Finn PV, Velazquez E, Ertl G, et al. Sudden death in patients with myocardial infarction and left ventricular dysfunction, heart failure, or both. N Engl J Med. 2005;352:2581-8. [PMID: 15972864] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From Duke University Clinical Research Institute, Durham, NC 27710.Disclosures: Grants received: S.M. Al-Khatib (Medtronics Inc., Guidant Corp.). PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoClinical and Economic Implications of the Multicenter Automatic Defibrillator Implantation Trial-II Sana M. Al-Khatib , Kevin J. Anstrom , Eric L. Eisenstein , Eric D. Peterson , James G. Jollis , Daniel B. Mark , Yun Li , Christopher M. O'Connor , Linda K. Shaw , and Robert M. Califf Implications of the Multicenter Automatic Defibrillator Implantation Trial-II William S. Weintraub Implications of the Multicenter Automatic Defibrillator Implantation Trial-II Fahim H. Jafary Metrics 3 January 2006Volume 144, Issue 1Page: 65-66KeywordsAldosteroneClinical trialsConflicts of interestCoronary revascularizationDrug therapyHealth careHeart failure ePublished: 3 January 2006 Issue Published: 3 January 2006 Copyright & PermissionsCopyright © 2006 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...