Subcutaneous Implantable Cardioverter-Defibrillator Therapy in Women.
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Garcia Rodrigue, Kerkouri Fawzi, Marquié Christelle, Ait Said Mina, Anselme Frédéric, Aoudjeghout Warda, Badenco Nicolas, Badoz Marc, Barra Sergio, Barthez Olivier, Blangy Hugues, Bordachar Pierre, Champ-Rigot Laure, Combes Stéphane, Defaye Pascal, Deharo Jean Claude, Gandjbakhch Estelle, Gitenay Edouard, Gorka Hervé, Heurtebise Isabelle, Hourdain Jérôme, Jesel Laurence, Khris Lila, Lebon Alain, Leclercq Christophe, Le Page Sophie, Mechulan Alexis, Mondoly Pierre, Pasquié Jean-Luc, Perrot David, Pierre Bertrand, Piot Olivier, Quentin Anne, Rendu Eric, Villejoubert Olivier, Waldmann Victor, Weizman Orianne, Probst Vincent, Boveda Serge, Marijon Eloi, HONEST Investigators
Аннотация
OBJECTIVES: This study evaluated sex-related differences in baseline characteristics, appropriate shocks, complications, reinterventions, and mortality among S-ICD recipients.
METHODS: The nationwide HONEST (S-ICD French Cohort Study) cohort enrolled all patients who received an S-ICD in France between 2012 and 2019. Clinical endpoints were centrally adjudicated. Sex-specific associations with outcomes were assessed by using propensity score-based inverse probability weighting.
RESULTS: Among 4,924 S-ICD recipients, 1,148 were women (23.3%). Compared with men, women were younger (47.3 ± 15.6 years vs 50.6 ± 14.7 years; P < 0.001), less frequently received an implant for primary prevention (57.6% vs 65.1%; P < 0.001), less often had coronary artery disease (38.9% vs 56.5%; P < 0.001), and more often had electrical heart disease (26.3% vs 20.4%; P < 0.001). After adjustment, women had a lower 5-year risk of appropriate shocks (HR: 0.85; 95% CI: 0.74-0.98; P = 0.023) and similar overall complication and reintervention rates but a distinct complication profile, with higher risks of chronic pain (HR: 2.63; 95% CI: 1.61-4.29; P < 0.001) and lead dislodgment (HR: 1.79; 95% CI: 1.09-2.95; P = 0.022) and a lower risk of inappropriate shocks (HR: 0.64; 95% CI: 0.50-0.82; P < 0.001). All-cause mortality was lower in women, whereas S-ICD-unresponsive sudden death and device-related mortality were similar.
CONCLUSIONS: Women receiving an S-ICD experienced fewer appropriate shocks, with similar overall complication and reintervention rates, but a distinct complication profile. These findings support sex-informed S-ICD selection and follow-up. (S-ICD French Cohort Study [HONEST]; NCT05302115).