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Europace Advance Access originally published online on March 11, 2009
Europace 2009 11(6):734-740; doi:10.1093/europace/eup055
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2009. For permissions please email: journals.permissions@oxfordjournals.org
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ICD

Predictors of early mortality in implantable cardioverter-defibrillator recipients

Kenneth M. Stein1,*, Suneet Mittal2, F. Roosevelt Gilliam3, David M. Gilligan4, Qian Zhong5, Stacia Merkel Kraus6 and Timothy E. Meyer7

1 Maurice and Corinne Greenberg Division of Cardiology, Department of Medicine, Weill Medical College of Cornell University, 520 East 70th Street, Starr-4, New York, NY 10021, USA; 2 St Luke's-Roosevelt Hospital Center, New York, NY, USA; 3 Cardiology Associates of NE Arkansas, Jonesboro, AR, USA; 4 Virginia Cardiovascular Specialists, Richmond, VA, USA; 5 University of California, Los Angeles, Los Angeles, CA, USA; 6 The Integra Group, Brooklyn Park, MN, USA; 7 Boston Scientific, St Paul, MN, USA

Aims: Multiple trials have shown that implantable cardioverter defibrillators (ICDs) prolong survival in secondary and primary prevention populations. However, in spite of the efficacy of these devices in terminating life-threatening arrhythmias, total mortality remains high.

Methods and results: We evaluated 1703 patients (mean age: 67 ± 12 years, 82% male) with conventional ICD indications, who were enrolled and followed between 2001 and 2004 at 128 US centres. Patients were followed for up to a year, and vital status was obtained for 1655 patients (97%, median follow-up: 377 days). There were 183 deaths within 1 year of ICD implantation (1-year mortality rate: 16%). Predictors of mortality included a history of atrial fibrillation (AF, P < 0.0001), diabetes (P = 0.0001), failure to use cholesterol-lowering medications (P < 0.001), use of digitalis and derivatives (P < 0.0001), use of diuretics (P < 0.0001), low body mass index (BMI, P < 0.0001), increasing age (P < 0.0001), low left ventricular ejection fraction (P < 0.0001), low activity hours (P < 0.0001), elevated resting heart rate (P = 0.014), low mean arterial pressure (MAP, P = 0.007), and poor functional status (New York Heart Association class, P < 0.0001). In multivariate modelling, AF (P ≤ 0.001), diabetes (P = 0.004), BMI (P = 0.001), MAP (P = 0.040), and functional class (P = 0.006) predicted mortality.

Conclusion: In this population undergoing ICD implantation, poor functional status, low MAP, diabetes, low BMI, and AF were strongly associated with death within a year.

Key Words: Implantable cardioverter defibrillators (ICDs), Mortality, Risk stratification

* Corresponding author. Tel: +1 212 746 2158, Fax: +1 212 746 6951, Email: kstein{at}mail.med.cornell.edu

Manuscript submitted 7 November 2008. Accepted after revision 9 February 2009.


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Early mortality in implantable cardioverter defibrillator patients: from randomized controlled trials to real life
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Europace 2009 11: 694-696. [Full Text]  



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