Development and external validation of prediction models to predict implantable cardioverter-defibrillator efficacy in primary prevention of sudden cardiac death.
Implantable cardioverter-defibrillator
Mortality
Prediction models
Primary prevention
Risk factors
Sudden cardiac death
Journal
Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology
ISSN: 1532-2092
Titre abrégé: Europace
Pays: England
ID NLM: 100883649
Informations de publication
Date de publication:
07 06 2021
07 06 2021
Historique:
received:
03
09
2020
accepted:
08
01
2021
pubmed:
15
2
2021
medline:
10
8
2021
entrez:
14
2
2021
Statut:
ppublish
Résumé
This study was performed to develop and externally validate prediction models for appropriate implantable cardioverter-defibrillator (ICD) shock and mortality to identify subgroups with insufficient benefit from ICD implantation. We recruited patients scheduled for primary prevention ICD implantation and reduced left ventricular function. Bootstrapping-based Cox proportional hazards and Fine and Gray competing risk models with likely candidate predictors were developed for all-cause mortality and appropriate ICD shock, respectively. Between 2014 and 2018, we included 1441 consecutive patients in the development and 1450 patients in the validation cohort. During a median follow-up of 2.4 (IQR 2.1-2.8) years, 109 (7.6%) patients received appropriate ICD shock and 193 (13.4%) died in the development cohort. During a median follow-up of 2.7 (IQR 2.0-3.4) years, 105 (7.2%) received appropriate ICD shock and 223 (15.4%) died in the validation cohort. Selected predictors of appropriate ICD shock were gender, NSVT, ACE/ARB use, atrial fibrillation history, Aldosterone-antagonist use, Digoxin use, eGFR, (N)OAC use, and peripheral vascular disease. Selected predictors of all-cause mortality were age, diuretic use, sodium, NT-pro-BNP, and ACE/ARB use. C-statistic was 0.61 and 0.60 at respectively internal and external validation for appropriate ICD shock and 0.74 at both internal and external validation for mortality. Although this cohort study was specifically designed to develop prediction models, risk stratification still remains challenging and no large group with insufficient benefit of ICD implantation was found. However, the prediction models have some clinical utility as we present several scenarios where ICD implantation might be postponed.
Identifiants
pubmed: 33582797
pii: 6134882
doi: 10.1093/europace/euab012
pmc: PMC8184225
doi:
Substances chimiques
Angiotensin Receptor Antagonists
0
Angiotensin-Converting Enzyme Inhibitors
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
887-897Informations de copyright
© The Author(s) 2021. Published by Oxford University Press on behalf of the European Society of Cardiology.
Références
J Am Coll Cardiol. 2012 Jun 5;59(23):2075-9
pubmed: 22651863
J Am Coll Cardiol. 2008 Sep 30;52(14):1111-21
pubmed: 18804736
Int J Cardiol. 2018 Dec 1;272:102-107
pubmed: 29983251
Heart Rhythm. 2019 Jul;16(7):1057-1064
pubmed: 30710738
Europace. 2013 Dec;15(12):1693-701
pubmed: 23946316
Neth Heart J. 2017 Oct;25(10):574-580
pubmed: 28785868
N Engl J Med. 2005 Jan 20;352(3):225-37
pubmed: 15659722
Eur Heart J. 2020 Jun 1;41(21):1976-1986
pubmed: 31750896
N Engl J Med. 2002 Mar 21;346(12):877-83
pubmed: 11907286
JACC Clin Electrophysiol. 2017 Mar;3(3):291-298
pubmed: 28553663
Europace. 2009 Sep;11(9):1129-33
pubmed: 19578174
Europace. 2014 Jan;16(1):40-6
pubmed: 23918791
Lancet. 2019 Oct 12;394(10206):1344-1351
pubmed: 31488371
BMJ. 2015 Jan 07;350:g7594
pubmed: 25569120
Europace. 2015 Nov;17(11):1601-87
pubmed: 26318695
Europace. 2017 Jan;19(1):72-80
pubmed: 28130376
Circ Heart Fail. 2015 Sep;8(5):927-37
pubmed: 26224792
Eur Heart J. 2014 Oct 14;35(39):2733-79
pubmed: 25173338
Circulation. 2006 Mar 21;113(11):1424-33
pubmed: 16534009
N Engl J Med. 2016 Sep 29;375(13):1221-30
pubmed: 27571011