Men had higher MACE and all-cause mortality post-CRT-P/D than women regardless of diabetes status; women had more non-ischemic device indications without diabetes.
Do indications, complications, and outcomes of de novo ICD and CRT implantation differ between sexes, and are these differences affected by type 2 diabetes status?
Women receiving ICDs or CRTs have more non-ischemic indications and higher rates of mechanical complications compared to men, though men experience higher long-term MACE and mortality, with type 2 diabetes narrowing the sex disparity in indications.
Absolute Event Rate: 0% vs 0%
Abstract Background Women receive implantable cardioverter defibrillators (ICDs) and cardiac resynchronization therapy-pacemaker/defibrillator (CRT-P/D) less often than men. A potential explanation is that female sex protects against ischemic heart disease (IHD), one of the main reasons for a need of ICDs and CRTs. However, this protection may diminish with concomitant diabetes. Purpose This study explores if diabetes affects sex differences in ICD and CRT indications, outcomes, and complications. Methods This Swedish retrospective registry-based study included 24,143 patients aged ≥18 years who were implanted with a de novo ICD or CRT-D/P implantation from January 2010 to December 2021 and followed until December 2021. Data from six national registries were combined to assess baseline characteristics, ICD/CRT indications, and one-year complications using chi-square tests, and for outcomes (MACE/all-cause mortality) Kaplan-Meier curves and Cox regression models. Comparisons were made between sexes in subgroups based on device types, further stratified by the presence of type 2 diabetes (T2DM) or without diabetes (No-DM). Type 1 diabetes was excluded due to a low sample size causing insufficient statistical power. Results Women, 22% of the total population, were younger than men (65.6 vs. 67.5 years; p0.0001) at implantation. Men had higher prevalence of known IHD and ventricular tachycardia/fibrillation (VT/VF) at baseline and as indication for implantation irrespective of the presence of T2DM (p0.0001). Structural myocardial disease was a more frequent indication in women than men, especially in the No-DM group, as an indication for cardiac devices, e.g. dilated cardiomyopathy (31.6% vs. 25.9%, p0.0001) and sarcoidosis (1.3% vs. 0.9%, p=0.0108). The risk for mechanical complications was higher in women than men in the No-DM group: pneumothorax (0.4% vs. 1.3%, p=0.0025) with CRT-D and perforation/tamponade (0.3% vs. 0.9%, p=0.0004) with ICDs. Men with CRT-P/D had a higher MACE rate and all-cause mortality after adjustment for demographics (e.g. age, sex, educational level), IHD and heart failure both in the T2DM and No-DM groups (Table 1; Figure 1). The presence of T2DM did not influence the sex-related differences in outcome. Conclusion Non-ischemic indications were more prevalent among women without diabetes than men. A potential explanation may be an increased ischemic risk in women with T2DM narrowing the sex-related disparity in indications for a device implantation.
Zhou et al. (Sat,) reported a other. Men had higher MACE and all-cause mortality post-CRT-P/D than women regardless of diabetes status; women had more non-ischemic device indications without diabetes.
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