Garcia Rodrigue, Boveda Serge, Defaye Pascal, Sadoul Nicolas, Narayanan Kumar, Perier Marie-Cécile, Klug Didier, Fauchier Laurent, Leclercq Christophe, Babuty Dominique, Bordachar Pierre, Gras Daniel, Deharo Jean-Claude, Piot Olivier, Providencia Rui, Marijon Eloi, Algalarrondo Vincent
CHU Poitiers, 86021, Poitiers, France.
Clinique Pasteur, 31076, Toulouse, France.
Int J Cardiol. 2020 Feb 15;301:114-118. doi: 10.1016/j.ijcard.2019.09.033. Epub 2019 Oct 30.
According to guidelines, implantable cardioverter defibrillator (ICD) candidates must have a "reasonable expectation of survival with a good functional status >1 year". Identifying risk for early mortality in ICD candidates could be challenging. We aimed to identify factors associated with a ≤1-year survival among patients implanted with ICDs.
The DAI-PP program was a multicenter, observational French study that included all patients who received a primary prevention ICD in the 2002-2012 period. Characteristics of patients who survived ≤1 year following the implantation were compared with those who survived >1 year, and predictors of early death determined.
Out of the 5539 enrolled patients, survival status at 1 year was known for a total of 5,457, and overall 230 (4.2%) survived ≤1 year. Causes of death were similar in the two groups. Patients with ≤1-year survival had lower rates of appropriate (14 vs. 23%; P = 0.004) and inappropriate ICD therapies (2 vs. 7%; P = 0.009) than patients who lived >1 year after ICD implantation. In multivariate analysis, older age, higher NYHA class (≥III), and atrial fibrillation were significantly associated with ≤1-year survival. Presence of all 3 risk factors was associated with a cumulative 22.63% risk of death within 1 year after implantation.
This is the largest study determining the factors predicting early mortality after ICD implantation. Patients dying within the first year had low ICD therapy rates. A combination of clinical factors could potentially identify patients at risk for early mortality to help improve selection of ICD candidates.
根据指南，植入式心脏复律除颤器（ICD）候选者必须有“功能状态良好且生存期>1年的合理预期”。识别ICD候选者的早期死亡风险可能具有挑战性。我们旨在确定与植入ICD患者1年内存活率≤1年相关的因素。
DAI-PP项目是一项多中心、观察性的法国研究，纳入了2002年至2012年期间接受一级预防ICD的所有患者。将植入后存活≤1年的患者特征与存活>1年的患者特征进行比较，并确定早期死亡的预测因素。
在5539名登记患者中，共有5457名患者的1年生存状态已知，总体上230名（4.2%）存活≤1年。两组的死亡原因相似。与ICD植入后存活>1年的患者相比，存活≤１年的患者适当（14%对23%；P=0.004）和不适当ICD治疗（2%对7%；P=0.009）的发生率较低。在多变量分析中，年龄较大、纽约心脏协会（NYHA）分级较高（≥III级）和心房颤动与≤1年的生存期显著相关。所有这3个危险因素的存在与植入后1年内累积22.63%的死亡风险相关。
这是确定ICD植入后预测早期死亡因素的最大规模研究。在第一年死亡的患者ICD治疗率较低。临床因素的组合可能有助于识别有早期死亡风险的患者，以帮助改进ICD候选者的选择。
