Nishimura Marin, Sab Shiv, Birgersdotter-Green Ulrika, Krummen David, Schricker Amir, Raissi Farshad, Hoffmayer Kurt S, Feld Gregory K, Hsu Jonathan C
Cardiac Electrophysiology Section, Division of Cardiology, Department of Medicine, University of California, San Diego, 9452 Medical Center Dr, 3rd Fl, Rm 3E-417, La Jolla, CA, 92037, USA.
J Interv Card Electrophysiol. 2017 Oct;50(1):85-93. doi: 10.1007/s10840-017-0283-1. Epub 2017 Aug 26.
Implantable cardioverter-defibrillator (ICD) implantation is often an elective outpatient procedure, but previous studies have shown that approximately 30% are performed during acute hospitalizations.
This study aims to identify predictors of acute hospitalization versus elective outpatient ICD implantation and evaluate differential clinical outcomes.
We studied 327 first-time ICD recipients between 2011 and 2015. All patients receiving a primary prevention ICD were optimized on guideline directed medical therapy (GDMT) prior to consideration for device implantation. Using multivariate logistic regression, we examined predictors of ICD implantation during acute hospitalization. Cox proportional hazard regression was used adjusting for patient characteristics to examine associations with clinical outcomes including complications, device therapy, heart failure re-admission, and death.
Of all patients, 132 (40.3%) underwent ICD implantation during acute hospitalization, most frequently performed for secondary prevention (n = 76, 57.6%). The most common reason for acute hospitalization ICD implantation in primary prevention patients was an indication for pacing (n = 20, 35.7%). In multivariable adjusted models, secondary prevention indication, non-single chamber device, NYHA class IV symptoms, lower diastolic blood pressure, higher BUN, and lower hemoglobin were significant predictors of ICD implantation during an acute hospitalization. In univariate analysis, acute hospitalization ICD implantation was associated with a higher risk of heart failure re-admission (HR = 1.6, 95% CI 1.1-2.4) and mortality (HR = 3.0, 95% CI 1.1-8.0) but no difference in risk of ICD therapy (HR = 1.4, 95% CI 0.9-2.3) or adverse events (HR = 1.1, 95% CI 0.6-2.1). After multivariable adjustment for potential confounders, all outcomes were no different between acute hospitalization versus elective outpatient ICD recipients.
Among first-time ICD recipients, specific clinical characteristics predicted acute hospitalization ICD implantation. After adjustment for potential confounders, acute hospitalization ICD implantation was not associated with increased risk of morbidity or mortality.
植入式心脏复律除颤器（ICD）植入术通常是一项择期门诊手术，但既往研究表明，约30%的手术是在急性住院期间进行的。
本研究旨在确定急性住院与择期门诊ICD植入的预测因素，并评估不同的临床结局。
我们研究了2011年至2015年间327例首次接受ICD植入的患者。所有接受一级预防ICD的患者在考虑植入设备之前均接受了指南指导的药物治疗（GDMT）优化。使用多因素逻辑回归分析，我们研究了急性住院期间ICD植入的预测因素。采用Cox比例风险回归分析，并对患者特征进行调整，以研究与临床结局（包括并发症、设备治疗、心力衰竭再入院和死亡）的相关性。
在所有患者中，132例（40.3%）在急性住院期间接受了ICD植入，最常见于二级预防（n = 76，57.6%）。一级预防患者急性住院期间ICD植入的最常见原因是起搏指征（n = 20，35.7%）。在多变量调整模型中，二级预防指征、非单腔设备（植入式心律转复除颤器）、纽约心脏协会（NYHA）IV级症状、较低的舒张压、较高的血尿素氮（BUN）和较低的血红蛋白是急性住院期间ICD植入的显著预测因素。在单变量分析中，急性住院期间ICD植入与心力衰竭再入院风险较高（HR = 1.6，95%CI 1.1 - 2.4）和死亡率较高（HR = 3.0，95%CI 1.1 - 8.0）相关，但在ICD治疗风险（HR = 1.4，95%CI 0.9 - 2.3）或不良事件风险（HR = 1.1，95%CI 0.6 - 2.1）方面无差异。在对潜在混杂因素进行多变量调整后，急性住院与择期门诊ICD接受者之间的所有结局均无差异。
在首次接受ICD植入的患者中，特定的临床特征可预测急性住院期间的ICD植入。在对潜在混杂因素进行调整后，急性住院期间ICD植入与发病率或死亡率增加无关。
