Abstract 3628: Differences in Implantation-Related Complications between Men and Women Receiving ICD Therapy for Primary Prevention
Background: Studies suggest that women are at higher risk for complications with some invasive cardiac procedures. Little is known about ICD implantation-related complications in community practice. We compared rates of in-hospital complications in men and women receiving an ICD for primary prevention.
Methods: Using the NCDR ICD registry, we identified a cohort of patients receiving an ICD for primary prevention of sudden cardiac death between January 2005 and April 2007. Outcomes included all complications and major complications (cardiac arrest, perforation, valve injury, coronary venous dissection, hemothorax, pneumothorax, deep phlebitis, TIA/stroke, tamponade, MI, and AV fistula). Multivariable analysis assessed the association between gender and complications, adjusting for demographic, clinical, procedural, physician, and hospital characteristics. Secondary analyses stratified by device type (ICD vs. biventricular (BiV) ICD).
Results: Of the 59,833 patients, 73% were male and 27% were female. Women were more likely to have a history of heart failure (88% vs. 83%; p<0.01), worse NYHA functional status (57% vs. 50% NYHA Class III; p<0.01), and non-ischemic cardiomyopathy (47% vs. 28%; p<0.01). Women were also more likely to receive BiV ICDs (46% vs. 39%; p<0.01). In unadjusted analyses, women were more likely to experience any complication and major complications (Table⇓). In multivariable models, women had a significantly higher risk of any complications and major complications. Results were similar when stratified by device type.
Conclusions: Women are more likely than men to have in-hospital complications related to ICD implantation. As complications attenuate the benefits that might accrue from ICD therapy, the higher risk of complications may influence the decision to implant a device in women. Additionally, strategies specifically directed at preventing complications will be important to improving outcomes after ICD implantation.