Meta-analysis of 18 randomized controlled trials reveals that patients with a 3% annual sudden cardiac death (SCD) risk represent the minimum threshold for meaningful benefit from implantable cardioverter-defibrillator (ICD) therapy. The analysis found ICDs reduce SCDs with 56% efficacy, but competing non-sudden mortality significantly impacts overall survival benefits. This threshold translates to approximately 12% five-year SCD risk and achieves a clinically relevant number-needed-to-treat of 21 or fewer patients. The finding addresses a critical gap in cardiovascular medicine where no consensus exists for SCD risk thresholds in clinical decision-making. For the estimated 350,000 Americans experiencing sudden cardiac arrest annually, this threshold could dramatically improve patient selection for expensive ICD implantation, potentially saving healthcare systems billions while focusing life-saving interventions on those most likely to benefit. However, this preprint awaits peer review, and the simulation-based methodology may not capture all real-world clinical complexities. The research represents an important step toward precision cardiology, though validation in diverse patient populations and consideration of individual patient factors beyond statistical risk models remains essential for clinical implementation.