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Predictors for early mortality and arrhythmic events in patients with cardiac resynchronization therapy with defibrillator: A two center cohort study
Affiliations- Department of Cardiology, University Hospital, Basel, Switzerland
- Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
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Abstract
Background: Guidelines of heart failure therapy include cardiac resynchronization as standard of
care in patients with severely depressed left ventricular function and wide QRS complex. It has been
shown that patients benefit regarding mortality and morbidity. However, early mortality precludes longterm
benefits from the device. The aim of the study was to identify predictors for early occurrence of
both death and first-ever implantable cardioverter-defibrillator (ICD) therapy using a large combined
database of patients with cardiac resynchronization therapy with defibrillator (CRT-D).
Methods: From two registries (tertiary care centers) 904 patients were identified, no single patient was
excluded. Early death was defined as death occurring within the 3 years after implantation whereas
early ICD therapy as such occurring within the first year. 33 baseline parameters were compared using
uni- and multivariate analysis with the Cox model and binary logistic regression.
Results: The population was predominantly male (77%), with mean age of 63 ± 11 years and primary
prevention indication in 80%. Mean follow-up was 55 ± 38 months. 256 (28%) patients had
ICD therapies whereof the first-ever event occurred early in 52%. 270 (30%) patients died after 41 ±
± 31 months, mostly from advancing heart failure (41%), 141 (52%) patients of them early. Independent
predictors for early ICD therapy were secondary prevention and renal failure. Independent predictors for
early mortality were a history of percutaneous coronary intervention and of peripheral vascular disease.
Conclusions: Predictors for early mortality after CRT-D implantation were a history of percutaneous
coronary intervention and peripheral vascular disease, present in only a minority of patients, thus limiting
their use in clinical practice.
Abstract
Background: Guidelines of heart failure therapy include cardiac resynchronization as standard of
care in patients with severely depressed left ventricular function and wide QRS complex. It has been
shown that patients benefit regarding mortality and morbidity. However, early mortality precludes longterm
benefits from the device. The aim of the study was to identify predictors for early occurrence of
both death and first-ever implantable cardioverter-defibrillator (ICD) therapy using a large combined
database of patients with cardiac resynchronization therapy with defibrillator (CRT-D).
Methods: From two registries (tertiary care centers) 904 patients were identified, no single patient was
excluded. Early death was defined as death occurring within the 3 years after implantation whereas
early ICD therapy as such occurring within the first year. 33 baseline parameters were compared using
uni- and multivariate analysis with the Cox model and binary logistic regression.
Results: The population was predominantly male (77%), with mean age of 63 ± 11 years and primary
prevention indication in 80%. Mean follow-up was 55 ± 38 months. 256 (28%) patients had
ICD therapies whereof the first-ever event occurred early in 52%. 270 (30%) patients died after 41 ±
± 31 months, mostly from advancing heart failure (41%), 141 (52%) patients of them early. Independent
predictors for early ICD therapy were secondary prevention and renal failure. Independent predictors for
early mortality were a history of percutaneous coronary intervention and of peripheral vascular disease.
Conclusions: Predictors for early mortality after CRT-D implantation were a history of percutaneous
coronary intervention and peripheral vascular disease, present in only a minority of patients, thus limiting
their use in clinical practice.
Keywords
cardiac resynchronization therapy, implantable cardioverter-defibrillator, mortality, predictive model, decision making
About this articleTitle
Predictors for early mortality and arrhythmic events in patients with cardiac resynchronization therapy with defibrillator: A two center cohort study
Journal
Issue
Pages
711-716
Published online
2018-11-26
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1850
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738
DOI
Pubmed
Bibliographic record
Cardiol J 2019;26(6):711-716.
Keywords
cardiac resynchronization therapy
implantable cardioverter-defibrillator
mortality
predictive model
decision making
Authors
Simon von Gunten
Dominic A. Theuns
Michael Kühne
Tobias Reichlin
Christian Sticherling
Beat Schaer
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