Abstract 17144: Risk for Non-Arrhythmic Mortality in “Real-Life” Patients with Implantable Cardioverter Defibrillators in Primary Prevention
Introduction: The occurrence of non-arrhythmic death may decrease the potential interest of implantable cardioverter defibrillator (ICD), especially among heart failure patients in primary prevention. The extent to which a published risk scheme from a randomized controlled trial of patients with ischemic heart disease is valid in “real life” patients with dilated cardiomyopathy and cardiac resynchronisation therapy (CRT) has not been addressed so far.
Methods: Of the 2,398 patients enrolled in the DAI-PP program (Evaluation of ICD in Primary Prevention in France), from 2002 to 2012, we evaluated frequencies and predictive values of the following risk factors for overall and specific causes of death: NYHA class III or IV, age > 70 years, QRS duration >120ms, atrial fibrillation and glomerular filtration rate < 60ml/min. Sensitivity analyses were performed for ischemic, non-ischemic cardiomyopathy and CRT patients.
Results: After a mean follow-up of 3.0±2.1 years, the overall mortality rate was 17.7% (95%CI 16.3-19.3). The incidence for overall mortality increased progressively alongside with the number of risk factors: 2.5, 2.9, 4.8, 9.0, 12.3 and 14.8 per 100 patient-years (P <0.001). The excess of mortality was mainly the consequence of an increase in non-arrhythmic mortality, from 3.5% to 24.4% (P<0.001), whereas ICD-unresponsive sudden death (ranging from 0.4 to 1.0 per 100 patient-years) and the occurrence of appropriate ICD therapies (from 7.4 to 8.8 per 100 patent-years) did not significantly change across the groups. A similar performance of the score was observed for ischemic (c-statistic = 0.685), non-ischemic cardiomyopathy (c-statistic = 0.658) and CRT patients (c-statistic = 0.678).
Conclusion: This cause of death analysis suggests the feasibility to identify patients at high-risk of non-arrhythmic death among “real-life” patients with ICD in primary prevention. Further studies are needed to improve and validate the most adequate cutoff values before wide use in real life for selecting patients for ICD therapy.
Author Disclosures: E. Marijon: None. R. Providencia: None. D. Klug: None. P. Defaye: None. M. Perier: None. O. Piot: None. N. Sadoul: None. V. Algalarrondo: None. A. Bouzeman: None. D. Gras: None. L. Fauchier: None. P. Bordachar: None. D. Babuty: None. J. Deharo: None. C. Leclercq: None. S. Boveda: None.
- © 2014 by American Heart Association, Inc.