Development and external validation of prediction models to predict implantable cardioverter-defibrillator efficacy in primary prevention of sudden cardiac death.
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Verstraelen Tom E, van Barreveld Marit, van Dessel Pascal H F M, Boersma Lucas V A, Delnoy Peter-Paul P H M, Tuinenburg Anton E, Theuns Dominic A M J, van der Voort Pepijn H, Kimman Gerardus P, Buskens Erik, Hulleman Michiel, Allaart Cornelis P, Strikwerda Sipke, Scholten Marcoen F, Meine Mathias, Abels René, Maass Alexander H, Firouzi Mehran, Widdershoven Jos W M G, Elders Jan, van Gent Marco W F, Khan Muchtiar, Vernooy Kevin, Grauss Robert W, Tukkie Raymond, van Erven Lieselot, Spierenburg Han A M, Brouwer Marc A, Bartels Gerard L, Bijsterveld Nick R, Borger van der Burg Alida E, Vet Mattheus W, Derksen Richard, Knops Reinoud E, Bracke Frank A L E, Harden Markus, Sticherling Christian, Willems Rik, Friede Tim, Zabel Markus, Dijkgraaf Marcel G W, Zwinderman Aeilko H, Wilde Arthur A M
Аннотация
METHODS AND RESULTS: We recruited patients scheduled for primary prevention ICD implantation and reduced left ventricular function. Bootstrapping-based Cox proportional hazards and Fine and Gray competing risk models with likely candidate predictors were developed for all-cause mortality and appropriate ICD shock, respectively. Between 2014 and 2018, we included 1441 consecutive patients in the development and 1450 patients in the validation cohort. During a median follow-up of 2.4 (IQR 2.1-2.8) years, 109 (7.6%) patients received appropriate ICD shock and 193 (13.4%) died in the development cohort. During a median follow-up of 2.7 (IQR 2.0-3.4) years, 105 (7.2%) received appropriate ICD shock and 223 (15.4%) died in the validation cohort. Selected predictors of appropriate ICD shock were gender, NSVT, ACE/ARB use, atrial fibrillation history, Aldosterone-antagonist use, Digoxin use, eGFR, (N)OAC use, and peripheral vascular disease. Selected predictors of all-cause mortality were age, diuretic use, sodium, NT-pro-BNP, and ACE/ARB use. C-statistic was 0.61 and 0.60 at respectively internal and external validation for appropriate ICD shock and 0.74 at both internal and external validation for mortality.
CONCLUSION: Although this cohort study was specifically designed to develop prediction models, risk stratification still remains challenging and no large group with insufficient benefit of ICD implantation was found. However, the prediction models have some clinical utility as we present several scenarios where ICD implantation might be postponed.