Key result
The IC-D score predicted persistent LVEF ≤35% at 6 weeks post-MI with an area under the curve of 0.83 in the derivation cohort and 0.73 in a multicenter validation cohort (p<0.0001).
Why the study?
Because reduced LVEF <=35% >=6 weeks post-MI can indicate prophylactic ICD implantation, the authors sought to identify predictors of an absence of significant LV remodeling.
Does the IC-D score predict persistent LVEF ≤35% at 6 weeks post-MI in patients with acute MI and LVEF ≤35% at discharge?
Cohort (n=300)
Yes
Does the IC-D score predict persistent LVEF ≤35% at 6 weeks post-MI in patients with acute MI and LVEF ≤35% at discharge?
The IC-D score, utilizing discharge LVEF and peak CPK, can effectively predict which post-MI patients will have persistent severe LV dysfunction at 6 weeks and require prophylactic ICD implantation.
Answers are grounded in this paper and cite their sources.
IC-D score may aid post-MI ICD risk stratification; leaves open prospective validation before changing practice.
BACKGROUND: A reduced left ventricular ejection fraction (LVEF) ≤35% ≥6 weeks following an acute myocardial infarction (MI) may indicate prophylactic implantation of a cardioverter-defibrillator (ICD). We sought to find predictors of absence of significant left ventricular (LV) remodeling post-MI. METHODS: All consecutive patients hospitalized for acute MI with an LVEF ≤35% at discharge in our institution from 2010 were retrospectively included. Patients were assigned to two groups according to the persistence of an LVEF ≤35% (ICD+) or a recovery >35% (ICD-). Logistic regression was performed to build a predictive score, which was then externally validated. RESULTS: Among a total of 1533 consecutive MI patients, 150 met inclusion criteria, 53 (35%) in the ICD+ group and 97 in the ICD group. After multivariable analyses, an LVEF ≤25% at discharge (adjusted OR 6.23 [2.47 to 17.0], p < .0001) and a CPK peak at the MI acute phase >4600 UI/L (adjusted OR 9.99 [4.27 to 25.3], p < .0001) both independently predicted non-recovery at 6 weeks. The IC-D (Increased Cpk-LV Dysfunction) score predicted persistent LVEF ≤35% with areas under curve of 0.83 and 0.73, in the study population and in a multicenter validation cohort of 150 patients, respectively (p < .0001). CONCLUSIONS: The association of a severely reduced LVEF and a major release of myocardial necrosis biomarkers at the acute phase of MI predict unfavorable remodeling, and prophylactic ICD implantation.
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Clémenty et al. (2021) conducted a cohort in Acute myocardial infarction with LVEF ≤35% (n=300). IC-D score was evaluated on Persistent LVEF ≤35% at 6 weeks (AUC 0.83, p=<0.0001). The IC-D score predicted persistent LVEF ≤35% at 6 weeks post-MI with an area under the curve of 0.83 in the derivation cohort and 0.73 in a multicenter validation cohort (p<0.0001).
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