Subcutaneous implantable cardioverter-defibrillator and defibrillation testing: A propensity-matched pilot study.
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Forleo Giovanni B, Gasperetti Alessio, Breitenstein Alexander, Laredo Mikael, Schiavone Marco, Ziacchi Matteo, Vogler Julia, Ricciardi Danilo, Palmisano Pietro, Piro Agostino, Compagnucci Paolo, Waintraub Xavier, Mitacchione Gianfranco, Carrassa Gianmarco, Russo Giulia, De Bonis Silvana, Angeletti Andrea, Bisignani Antonio, Picarelli Francesco, Casella Michela, Bressi Edoardo, Rovaris Giovanni, Calò Leonardo, Santini Luca, Pignalberi Carlo, Lavalle Carlo, Viecca Maurizio, Pisanò Ennio, Olivotto Iacopo, Curnis Antonio, Dello Russo Antonio, Tondo Claudio, Love Charles J, Di Biase Luigi, Steffel Jan, Tilz Roland, Badenco Nicolas, Biffi Mauro
Аннотация
OBJECTIVE: The purpose of this study was to compare long-term clinical outcomes of 2 propensity-matched cohorts of DT+ and DT- patients.
METHODS: Among consecutive S-ICD patients implanted across 17 centers from January 2015 to October 2020, DT- patients were 1:1 propensity-matched for baseline characteristics with DT+ patients. The primary outcome was a composite of ineffective shocks and cardiovascular mortality. Appropriate and inappropriate shock rates were deemed secondary outcomes.
RESULTS: Among 1290 patients, a total of 566 propensity-matched patients (283 DT+; 283 DT-) served as study population. Over median follow-up of 25.3 months, no significant differences in primary outcome event rates were found (10 DT+ vs 14 DT-; P = .404) as well as for ineffective shocks (5 DT- vs 3 DT+; P = .725). At multivariable Cox regression analysis, DT performance was associated with a reduction of neither the primary combined outcome nor ineffective shocks at follow-up. A high PRAETORIAN score was positively associated with both the primary outcome (hazard ratio 3.976; confidence interval 1.339-11.802; P = .013) and ineffective shocks alone at follow-up (hazard ratio 19.030; confidence interval 4.752-76.203; P = .003).
CONCLUSION: In 2 cohorts of strictly propensity-matched patients, DT performance was not associated with significant differences in cardiovascular mortality and ineffective shocks. The PRAETORIAN score is capable of correctly identifying a large percentage of patients at risk for ineffective shock conversion in both cohorts.