Predictors of appropriate interventions and mortality in patients with implantable cardioverter defibrillators.

Abstract

INTRODUCTION\nAdditional risk assessment in heart failure patients qualified for primary prevention cardioverter-defibrillator implantation is needed. The left ventricle ejection fraction (LVEF) reduction appears to be an insufficiently sensitive and specific marker of patients at greatest risk of sudden cardiac death.\n\n\nOBJECTIVES\nTo find short- and long-term predictors of appropriate implantable cardioverter-defibrillator (ICD) therapy and predictors of long-term mortality in patients implanted with an ICD/cardiac resynchronization defibrillator (CRT-D).\n\n\nPATIENTS AND METHODS\nA retrospective study analyzed data from 457 patients who had an ICD or CRT-D implanted between 2011 and 2017.\n\n\nRESULTS\nDuring the median observation period of 31 months (interquartile range [IQR] 17-52), 153 patients died (33.9%) and 140 had appropriate interventions (31.0%). In multivariate Cox regression analysis, implantation for secondary prevention (p < 0.001, hazard ratio, HR 2.49), severe mitral valve disease (p < 0.001, HR 2.17) and previous myocardial infarction (p = 0.009, HR 1.68) were predictors of appropriate intervention. Resynchronization therapy (p = 0.025, HR 0.59) and severe mitral valve disease (p < 0.001, HR 2.42) were significant predictors of appropriate intervention in primary prevention patients. Body mass index (BMI), hemoglobin concentration, LVEF, diabetes, and left atrium diameter were significant predictors of death.\n\n\nCONCLUSIONS\nSecondary prevention ICD/CRT-D implantation was a potent predictor of appropriate intervention, while resynchronization therapy and severe mitral regurgitation predicted ICD therapy in primary prevention patients. BMI, hemoglobin concentration, LVEF, diabetes, and left atrium diameter were independent mortality predictors in patients with ICD/CRT-D.