Predictors of appropriate interventions and mortality in patients with implantable cardioverter-defibrillators.

Introduction: Additional risk assessment in patients with heart failure referred for implantable cardioverter‑defibrillator (ICD) implantation as primary prevention is needed. A reduction in left ventricular ejection fraction (LVEF) seems to lack sufficient sensitivity and specificity to be used for identification of patients at the highest risk of sudden cardiac death.

Objectives: The aim of this study was to identify short- and long‑term predictors of appropriate implantable cardioverter‑defibrillator therapy as well as predictors of long‑term mortality in patients with an ICD or cardiac resynchronization therapy defibrillator (CRT‑D). Patients and

Methods: In this retrospective study, data from 457 patients who had an ICD or CRT‑D implanted between 2011 and 2017 were analyzed.

Results: During the median follow‑up of 31 months (interquartile range, 17-52 months), 153 patients died (33.9%) and 140 had appropriate interventions (31%). In a multivariate Cox regression analysis, implantation for secondary prevention (hazard ratio [HR], 2.49; P <0.001), severe mitral valve disease (HR, 2.17; P <0.001), and previous myocardial infarction (HR, 1.68; P = 0.009) were predictors of appropriate intervention. Resynchronization therapy (HR, 0.59; P = 0.025) and severe mitral valve disease (HR, 2.42; P <0.001) were predictors of appropriate intervention in primary prevention. Body mass index, hemoglobin concentrations, LVEF, diabetes, and left atrial diameter were significant predictors of death.

Conclusions: Implantation of ICD or CRT‑D as secondary prevention was a potent predictor of appropriate intervention, while resynchronization therapy and severe mitral regurgitation predicted ICD therapy in primary prevention. In patients with ICD or CRT-D, independent predictors of mortality included: body mass index, hemoglobin concentrations, LVEF, diabetes, and left atrial diameter.