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Survival of Patients With Primary Prophylactic ICD Indication (SPIRIT-ICD)

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT00619593
Recruitment Status : Completed
First Posted : February 21, 2008
Last Update Posted : January 12, 2015
Information provided by (Responsible Party):
Biotronik SE & Co. KG

Brief Summary:

The MADIT-II trial has shown that patients with severely reduced left ventricular ejection fraction (LVEF) post myocardial infarction benefit from the implantable cardioverter-defibrillator (ICD). However, retrospective analyses of the MADIT-II data have revealed a significantly increased morbidity and mortality in patients with appropriate ICD therapy: Appropriate ICD therapy is associated with 3.3-fold increased all-cause mortality, and the risk of a first heart failure hospitalization is 90% higher after 1st appropriate ICD therapy. Hence, the 1st appropriate therapy might indicate the necessity and utility of further clinical diagnostics and therapy in these patients.

This trial is designed to (i) improve the knowledge of the group characteristics of patients suffering from 1st appropriate ICD therapy, (ii) but moreover to take additional therapeutic steps to reduce the mortality of this patient population.

Condition or disease Intervention/treatment Phase
Primary Prevention Tachycardia, Ventricular Sudden Cardiac Death Other: Intensified diagnostic and treatment measures following 1st appropriate ICD therapy Other: Standard follow-up Phase 4

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 504 participants
Allocation: Non-Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Prevention
Official Title: Survival of Patients With Primary Prophylactic ICD Indication, Provided With Intensified Care After 1st ICD Therapy
Study Start Date : February 2008
Actual Primary Completion Date : April 2014
Actual Study Completion Date : July 2014

Arm Intervention/treatment
Active Comparator: 2
Standard follow-up in patients without appropriate ICD therapy
Other: Standard follow-up
Standard follow-up in patients without appropriate ICD therapy

Experimental: 1
Following 1st appropriate ICD therapy, the patients have to be called to the clinic for intensified clinical diagnostics and, if necessary or useful, intensified therapy.
Other: Intensified diagnostic and treatment measures following 1st appropriate ICD therapy
  • Assessment of general health status (weight, BP, NYHA)
  • Laboratory tests (hemoglobin, Nt-proBNP, creatinine, GDF-15)
  • Echocardiography (LVEF, LVEDD, mitral regurgitation)
  • Non-invasive ischemia evaluation
  • Coronary angiography (if indicated by ischemia evaluation)
  • Upgrade to CRT, if indicated
  • Ventricular ablation (if indicated: VT storm, slow VT, bundle branch reentry)
  • 24 hrs ECG Holter (Heart rate variability)
  • Further treatment (if applicable)
  • Changes in ICD settings, or medication
Other Name: Intensified diagnostic and treatment measures

Primary Outcome Measures :
  1. Mortality [ Time Frame: 12 months ]

Secondary Outcome Measures :
  1. Sudden cardiac death [ Time Frame: 12 months ]
  2. Non-sudden cardiac death [ Time Frame: 12 months ]
  3. Risk of 1st heart failure hospitalization [ Time Frame: 12 months ]
  4. No. of VT Storms (> 3 VT/24h) [ Time Frame: 12 months ]
  5. No. of delivered ICD therapies [ Time Frame: 12 months ]

Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • Indication for ICD implantation according to MADIT-II:

    • Myocardial infarction 30 days or more before implantation
    • LVEF of 30% or less within 3 months before implantation
  • Angiography within the preceding 12 months
  • The patient is willing and able to comply with the clinical investigation plan and has provided written informed consent

Exclusion Criteria:

  • Patients with contraindication for ICD implantation
  • Conventional ICD indication (i.e. other than MADIT-II)
  • Myocardial infarction within the past 30 days
  • Coronary revascularisation within the preceding 3 months (i.e., if revascularization has been performed wait at least 3 months until enrolment, given that no appropriate/ inappropriate ICD therapy has occured)
  • NYHA functional class IV
  • Unexplained syncope within 3 years
  • Advanced cerebrovascular disease
  • Life expectancy very probably below 12 months
  • Pregnant or breast-feeding women
  • Age < 18 years
  • Patients who are already enrolled in another study (therapy/intervention phase)

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT00619593

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Sponsors and Collaborators
Biotronik SE & Co. KG
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Principal Investigator: Robert Hatala, Prof. MUDr. Národný ústav srdcových a cievnych chorôb, Kardiologická klinika, Pod Krásnou Hôrkou 1, 833 48 Bratislava, Slovakia
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Responsible Party: Biotronik SE & Co. KG Identifier: NCT00619593    
Other Study ID Numbers: TA079
First Posted: February 21, 2008    Key Record Dates
Last Update Posted: January 12, 2015
Last Verified: January 2015
Keywords provided by Biotronik SE & Co. KG:
Heart failure
Ventricular Fibrillation
Sudden cardiac death
Hospitalization due to heart failure
Implantable cardioverter-defibrillator
Risk of 1st heart failure hospitalization
Additional relevant MeSH terms:
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Death, Sudden, Cardiac
Tachycardia, Ventricular
Pathologic Processes
Arrhythmias, Cardiac
Heart Diseases
Cardiovascular Diseases
Cardiac Conduction System Disease
Heart Arrest
Death, Sudden