Does device type (single-chamber ICD, dual-chamber ICD, or CRT-D) affect the risk of in-hospital MACCE and ICU utilization in patients undergoing defibrillator implantation?
In a real-world German cohort, CRT-D implantation was associated with the lowest risk of in-hospital MACCE despite patients having higher comorbidity burdens, whereas dual-chamber ICDs were associated with the highest ICU utilization and extended MACCE risk.
Abstract Background Implantable cardioverter-defibrillator (ICD) is a cornerstone therapy for the prevention of sudden cardiac death. However, clinical profiles and in-hospital outcomes may differ according to device type—single-chamber ICD, dual-chamber ICD, or cardiac resynchronization therapy defibrillator (CRT-D). This study aimed to compare hospitalization parameters and peri-procedural complications among patients receiving these device types. Methods We retrospectively analyzed 2,001 consecutive ICD recipients (single-chamber: 815; dual-chamber: 463; CRT-D: 723). Baseline characteristics, intensive care unit (ICU) utilization, procedure-related complications, and discharge outcomes were compared across groups. The main endpoint was defined as major adverse cardiovascular and cerebrovascular events (MACCE), and the second endpoint was defined as an extended MACCE including both MACCE and intensive care unit (ICU) admission. Results CRT-D recipients were older (67.5 ± 10.4 years, p < 0.01) and had a higher prevalence of comorbidities, including obesity (12.3%, p = 0.03), diabetes mellitus (30.2%, p = 0.04), permanent atrial fibrillation (10.1%, p < 0.01), and chronic kidney disease (31%, p < 0.01), compared with single- and dual-chamber ICD patients. Post-procedural ICU admission was highest in the dual-chamber ICD group (44.5%, p < 0.01), while ICU stay was shortest among CRT-D recipients (median 2.9 days, p < 0.01), who also required mechanical ventilation less frequently (8.7%, p < 0.01). Overall complication rates were lowest in the single-chamber ICD group (7.5%). Compared with single-chamber ICDs, implantation of dual-chamber ICDs was associated with a significantly higher risk of extended MACCE OR:1.65, (95% CI:1.30–2.09), whereas CRT-Ds were associated with a significantly lower risk OR:0.75, (95% CI:0.60–0.94). Furthermore, CRT-Ds were associated with a substantially lower extended MACCE risk compared with dual-chamber ICDs OR: 0.45, (95% CI:0.35–0x”.58). Defibrillator type and age emerged as significant predictors of MACCE. For the extended MACCE endpoint, defibrillator type remained a significant predictor, whereas age was not. Conclusion Despite their older age and higher comorbidity burden, recipients of CRT-D exhibited the lowest incidence of MACCE. Defibrillator type and age were identified as relevant predictors of MACCE in this patient population. Graphical abstract
Oezalp et al. (Thu,) studied this question.