SPC365

How to predict mortality in patients undergoing ICD implantation – is creatinine the new age?

Session: CO 23 - Dispositivos
Speaker: Mafalda Carrington

Congress: CPC 2021
Topic: C. Arrhythmias and Device Therapy
Theme: 09. Device Therapy
Subtheme: 09.2 Implantable Cardioverter / Defibrillator
Session Type: Comunicações Orais
FP Number: ---
Authors: Mafalda Carrington; Pedro Silvério António; Sara Couto Pereira; Joana Brito; Afonso Nunes-Ferreira; Rafael Santos; Igor Santos; Ivo Marcos; Lénia Coelho; Fausto j Pinto; João de Sousa; Pedro Marques
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:11.0pt">Introduction</span></strong><strong><span style="font-size:11.0pt">:</span></strong> <span style="font-size:11.0pt">Implantable Cardioverter Defibrillators (ICD) may be indicated in patients with ischaemic (i-CMP) or dilated noni-CMP with low ejection fraction (EF) and in selected patients with other CMP and channelopathies.</span><span style="font-size:11.0pt"> ICDs have been shown to reduce overall mortality comparing to medical therapy and they may be implanted </span><span style="font-size:11.0pt">for secondary prevention of sudden cardiac death (SCD) or for primary prevention. ICD therapy is not recommended in patients who do not have a reasonable expectation of survival for at least 1 year, although specific recommendations regarding clinical or functional status evaluation are lacking.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:11.0pt">Purpose: </span></strong><span style="font-size:11.0pt">To identify predictors of all-cause mortality in patients who implanted an ICD.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:11.0pt">Methods:</span></strong><span style="font-size:11.0pt"> Prospective single-center study of patients who implanted ICD between 2015 and 2019. C</span><span style="font-size:11.0pt">linical characteristics</span><span style="font-size:11.0pt"> were evaluated at baseline </span><span style="font-size:11.0pt">and mortality was assessed using the national registry of citizens. We performed univariate and multivariate analysis to compare clinical characteristics of patients who died and who survived using the Cox regression and Kaplan-Meier methods. For the predictor creatinine levels, we assessed the discrimination&nbsp;power and defined the best cut-off using the area under&nbsp;the ROC&nbsp;curve (AUC) method.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:11.0pt">Results:</span></strong><span style="font-size:11.0pt"> From 2015-2019, 414 ICDs were implanted (81% male, 62&plusmn;12 years-old), and 50(13%) of the patients died after a median follow-up of 23 [11-41] months. Patients who died during the follow-up were older (67&plusmn;9 vs 61&plusmn;12,p=0.002), had more diabetes (48% vs 33%,p=0.033) and a higher creatinine level (1.23 [0.84-1.86] vs 1.00 [0.84-1.22], p&lt;0.001). The remaining comorbidities were similar between both groups (Figure 1). Patients who died had more frequently an ICD implanted after a complication associated with a previous device or as a pacemaker upgrade (6% vs 2%, p=0.030). They also had a higher frequency of i-CMP (82% vs 56%, p=0.002) and of EF</span><span style="font-size:11.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">&le;</span></span><span style="font-size:11.0pt">50%(96% vs 82%, p=0.040). The best cut-off value of creatinine to predict mortality with a sensitivity of 65% and a specificity of 72% was 1.2mg/dl (AUC 0.650; CI95% 0.53-0.77). After adjusting for diabetes, i-CMP, EF</span><span style="font-size:11.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">&le;</span></span><span style="font-size:11.0pt">50% and upgrade/re-implantation after complication, we found that age (HR1.033; 95%CI 1.00-1.06, p=0.041) and creatinine</span><span style="font-size:11.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">&ge;</span></span><span style="font-size:11.0pt">1.2mg/dl (HR 2.134; 95%CI 1.09-4.19, p=0.028) were independent predictors of all-cause mortality (Figure 1).</span></span></span></p>

<p style="text-align:justify"><strong><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif">Conclusion:</span></span></strong><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif"> In our cohort of patients who underwent ICD implantation for primary or secondary SCD prevention, the all-cause mortality over a median follow-up period of </span></span><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif">23[11-41] months </span></span><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif">was 13%. We found that in addition to age, a baseline creatinine level</span></span><span style="font-size:11.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">&ge;</span></span><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif">1.2mg/dl increases by 2-fold mortality in patients who undergo ICD implantation. </span></span><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif">Decisions regarding ICD candidacy should not be based on age alone but should also consider creatinine factor that predisposes to mortality despite defibrillator implantation.</span></span></p>