Objectives: The goal of this study is a development of models that identify patients at risk of death during the first year after ICD implantation
Background: ICD implantation has become a principal therapy for secondary and primary prevention of sudden cardiac death. Although ICD implantation is an effective therapy in specific groups of patients. In some patients ICD Implantation is less effective or not effective at all.
Methods: Patient population derived from the Israeli ICD Registry - a prospective national registry of all patients who are referred for implantation or replacement of an ICD or CRT-D in Israel. Two groups of patients were compared: those who died during one year after ICD implantation and those who were still alive one year after ICD implantation. A primary end-point was a development of models for one year mortality after ICD implantation.
Results: A total of 1314 patients have completed at least one year follow up after first-time ICD or CRTD implantation at 22 centers. During one year after ICD implantation there were 63 (4.8%) fatal events. Age more than 75 years (hazard ratio [HR]:2.7; 95% confidence interval[CI]: 1.6 to 4.4) , history of atrial fibrillation (HR: 1.9; 95% CI: 1.12 to 3.17), chronic lung disease ( HR:2.0; 95% CI: 1.1 to 3.76) , anemia ( defined as Hb level less than 13 Gr/Dl in men and less than 12 Gr /Dl in women ) (HR: 2.3; 95% CI: 1.3 to 3.93) and decreased eGFR level ( 30 min/ml/1.73m²)( HR: 3.4; 95% CI: 1.74 to 6.6) were found to be independent risk factors for one-year mortality after ICD implantation. We propose a simple score for prediction of one year mortality after ICD implantation ("triple A , double C ") including : Age more than 75 years (3 points), Anemia (2 points), history of Atrial fibrillation (1 point), significant Chronic renal failure (GFR 30 min/ml/1.73m² (3 points) and Chronic lung disease (1 point). This model needs to be validated in other cohorts.
Conclusions: In the present study advanced age (more than 75 years), history of atrial fibrillation, chronic lung disease, anemia and decreased eGFR level ( 30 min/ml/1.73m²) were found as independent risk factors for one-year mortality after ICD implantation. The resulting risk score consists of clinical parameters may identify patients at high risk of death during one year after ICD implantation.
