A multivariable shock score stratified ICD patients into a high annual risk of appropriate shocks (10% per year in the upper quintile) versus a low risk (1.8% per year in the lower two quintiles).
Cohort (n=635)
Does a multivariable diagnostic strategy predict appropriate shock versus competing mortality in ICD patients?
A multivariable diagnostic strategy, particularly including EP stimulation, effectively differentiates the risk of appropriate ICD shocks from competing mortality in ICD patients.
BACKGROUND AND OBJECTIVE: We prospectively investigated combinations of risk stratifiers including multiple EP diagnostics in a cohort study of ICD patients. METHODS: For 672 enrolled patients, we collected history, LVEF, EP study and T-wave alternans testing, 24-h Holter, NT-proBNP, and the eGFR. All-cause mortality and first appropriate ICD shock were predefined endpoints. RESULTS: The 635 patients included in the final analyses were 63 ± 13 years old, 81% were male, LVEF averaged 40 ± 14%, 20% were inducible at EP study, 63% had a primary prophylactic ICD. During follow-up over 4.3 ± 1.5 years, 108 patients died (4.0% per year), and appropriate shock therapy occurred in n = 96 (3.9% per year). In multivariate regression, age (p < 0.001), LVEF (p < 0.001), NYHA functional class (p = 0.007), eGFR (p = 0.024), a history of atrial fibrillation (p = 0.011), and NT-pro-BNP (p = 0.002) were predictors of mortality. LVEF (p = 0.002), inducibility at EP study (p = 0.007), and secondary prophylaxis (p = 0.002) were identified as independent predictors of appropriate shocks. A high annualized risk of shocks of about 10% per year was prevalent in the upper quintile of the shock score. In contrast, a low annual risk of shocks (1.8% per year) was found in the lower two quintiles of the shock score. The lower two quintiles of the mortality score featured an annual mortality <0.6%. CONCLUSIONS: In a prospective ICD patient cohort, a very good approximation of mortality versus arrhythmic risk was possible using a multivariable diagnostic strategy. EP stimulation is the best test to assess risk of arrhythmias resulting in ICD shocks.
Bergau et al. (2018) conducted a cohort in ICD patients (n=635). Multivariable risk prediction was evaluated on All-cause mortality and first appropriate ICD shock. A multivariable shock score stratified ICD patients into a high annual risk of appropriate shocks (10% per year in the upper quintile) versus a low risk (1.8% per year in the lower two quintiles).