Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Am J Cardiol. 2023 Mar 15;191:32-38. doi: 10.1016/j.amjcard.2022.12.013. Epub 2023 Jan 10.
Data are limited regarding the characteristics and outcomes of patients with cancer who are found eligible for primary defibrillator therapy. We performed a single-center retrospective analysis of patients with preexisting cancer diagnoses who become eligible for a primary prevention implantable cardioverter defibrillator (ICD) or cardiac resynchronization therapy (CRT) defibrillator. Multicenter Automatic Defibrillator Implantation Trial-ICD (MADIT-ICD) benefit scores were calculated. The study included 75 cancer patients at a median age of 73 (interquartile range 64, 81) years at heart failure diagnosis. Active cancer was present in 51%. Overall, 55% of the cohort had coronary artery disease and 37% were CRT eligible. We found that 48%, 49%, and 3% of cohorts had low, intermediate, and high MADIT-ICD Benefit scores, respectively. Only 27% of patients underwent primary defibrillator implantation. Using multivariate analysis, indication for CRT and intermediate/high MADIT-ICD Benefit categories were found as independent predictors for implantation (odds ratio 8.42 p <0.001 and odds ratio 3.74 p = 0.040, respectively). During a median follow-up of 5.3 (interquartile range 4.5, 7.2) years, one patient (5%) with a defibrillator had appropriate shock therapy and 2 patients (10%) had bacteremia. Of 13 patients with CRT defibrillator-implants, one patient was admitted for heart failure exacerbation (8%). Using a time-varying covariate model, we did not observe statistically significant differences in the survival of patients with cancer implanted versus those not implanted with primary defibrillators (hazard ratio 0.521, p = 0.127). In conclusion, although primary defibrillator therapy is underutilized in patients with cancer, its relative benefit is limited because of competing risk of nonarrhythmic mortality. These findings highlight the need for personalized cardiologic and oncologic coevaluation.
关于符合条件接受原发性除颤器治疗的癌症患者的特征和结局的数据有限。我们对符合原发性预防植入式心脏复律除颤器 (ICD) 或心脏再同步治疗 (CRT) 除颤器条件的已确诊癌症患者进行了单中心回顾性分析。计算了多中心自动除颤器植入试验-ICD（MADIT-ICD）获益评分。该研究纳入了 75 名癌症患者，中位年龄为 73（64、81）岁，心力衰竭诊断时中位年龄为 73（64、81）岁。51%的患者存在活动性癌症。总的来说，55%的患者患有冠状动脉疾病，37%的患者符合 CRT 条件。我们发现，队列中有 48%、49%和 3%的患者分别具有低、中、高 MADIT-ICD 获益评分。仅 27%的患者接受了原发性除颤器植入。使用多变量分析，发现 CRT 适应证和中/高 MADIT-ICD 获益类别是植入的独立预测因素（优势比 8.42，p<0.001；优势比 3.74，p=0.040）。在中位随访 5.3（四分位间距 4.5、7.2）年期间，1 名（5%）有除颤器的患者接受了适当的电击治疗，2 名（10%）患者发生菌血症。在 13 名接受 CRT 除颤器植入的患者中，1 名（8%）患者因心力衰竭加重而住院。使用时变协变量模型，我们未观察到植入原发性除颤器与未植入原发性除颤器的癌症患者之间生存的统计学显著差异（风险比 0.521，p=0.127）。总之，尽管癌症患者的原发性除颤器治疗利用率较低，但由于非心律失常死亡率的竞争风险，其相对获益有限。这些发现强调了需要进行个体化心脏科和肿瘤科的共同评估。
