Department of Cardiology, Thorax Centrum Twente, Medisch Spectrum Twente, Haaksbergerstraat 55, 7513 ER Enschede, Enschede, The Netherlands.
Europace. 2014 Jan;16(1):40-6. doi: 10.1093/europace/eut223. Epub 2013 Aug 4.
To reduce sudden cardiac death, implantable cardioverter-defibrillators (ICDs) are indicated in patients with ischaemic and non-ischaemic dilated cardiomyopathy and a left ventricular ejection fraction (LVEF) ≤35%. Current guidelines do not recommend device therapy in patients with a life expectancy <1 year since benefit in these patients is low. In this study, we evaluated the incidence and predictors of early mortality (<1 year after implantation) in a consecutive primary prevention population.
Analysis was performed on a prediction and validation cohort. The primary endpoint was all-cause mortality at 1 year. The prediction cohort comprised 861 prophylactic ICD recipients with ischaemic cardiomyopathy or dilated cardiomyopathy from the Academic Medical Center (Amsterdam) and Thorax Center Twente (Enschede). Detailed clinical data were collected. After multivariate analysis, a risk score was developed based on age ≥75 years, LVEF ≤ 20%, history of atrial fibrillation, and estimated glomerular filtration rate (eGFR) ≤30 mL/min/1.73 m(2). Using these predictors, a low (≤1 factor), intermediate (2 factors), and high (≥3 factors) risk group could be identified with 1-year mortality of, respectively, 3.4, 10.9, and 38.9% (P< 0.01). Afterwards, the risk score was validated in 706 primary prevention patients from the Erasmus Medical Center (Rotterdam). One-year mortality was, respectively, 2.5, 13.2, and 46.3% (all P< 0.01).
A simple risk score based on age, LVEF, eGFR, and atrial fibrillation can identify patients at low, intermediate, and high risk for early mortality after ICD implantation. This may be helpful in the risk assessment of ICD candidates.
为了降低心源性猝死的风险，植入式心脏复律除颤器（ICD）适用于缺血性和非缺血性扩张型心肌病且左心室射血分数（LVEF）≤35%的患者。目前的指南不建议将该设备用于预期寿命<1 年的患者，因为这些患者的获益较低。在这项研究中，我们评估了连续的一级预防人群中早期死亡率（植入后 1 年内）的发生率和预测因素。
对预测和验证队列进行了分析。主要终点是 1 年时的全因死亡率。预测队列由来自学术医学中心（阿姆斯特丹）和特温特胸科中心（恩斯赫德）的 861 例缺血性心肌病或扩张型心肌病的预防性 ICD 接受者组成。收集了详细的临床数据。经过多变量分析，基于年龄≥75 岁、LVEF≤20%、心房颤动史和估算肾小球滤过率（eGFR）≤30mL/min/1.73m2，开发了一个风险评分。使用这些预测因素，可以确定低（≤1 个因素）、中（2 个因素）和高（≥3 个因素）风险组，其 1 年死亡率分别为 3.4%、10.9%和 38.9%（均<0.01）。之后，该风险评分在来自鹿特丹伊拉斯姆斯医学中心的 706 例一级预防患者中进行了验证。1 年死亡率分别为 2.5%、13.2%和 46.3%（均<0.01）。
基于年龄、LVEF、eGFR 和心房颤动的简单风险评分，可以识别 ICD 植入后早期死亡风险低、中、高的患者。这可能有助于对 ICD 候选者进行风险评估。
