TY - JOUR
T1 - Development and external validation of prediction models to predict implantable cardioverter-defibrillator efficacy in primary prevention of sudden cardiac death
AU - Verstraelen, Tom E
AU - van Barreveld, Marit
AU - van Dessel, Pascal H F M
AU - Boersma, Lucas V A
AU - Delnoy, Peter-Paul P H M
AU - Tuinenburg, Anton E
AU - Theuns, Dominic A M J
AU - van der Voort, Pepijn H
AU - Kimman, Gerardus P
AU - Buskens, Erik
AU - Hulleman, Michiel
AU - Allaart, Cornelis P
AU - Strikwerda, Sipke
AU - Scholten, Marcoen F
AU - Meine, Mathias
AU - Abels, René
AU - Maass, Alexander H
AU - Firouzi, Mehran
AU - Widdershoven, Jos W M G
AU - Elders, Jan
AU - van Gent, Marco W F
AU - Khan, Muchtiar
AU - Vernooy, Kevin
AU - Grauss, Robert W
AU - Tukkie, Raymond
AU - van Erven, Lieselot
AU - Spierenburg, Han A M
AU - Brouwer, Marc A
AU - Bartels, Gerard L
AU - Bijsterveld, Nick R
AU - Borger van der Burg, Alida E
AU - Vet, Mattheus W
AU - Derksen, Richard
AU - Knops, Reinoud E
AU - Bracke, Frank A L E
AU - Harden, Markus
AU - Sticherling, Christian
AU - Willems, Rik
AU - Friede, Tim
AU - Zabel, Markus
AU - Dijkgraaf, Marcel G W
AU - Zwinderman, Aeilko H
AU - Wilde, Arthur A M
N1 - Publisher Copyright:
© 2021 The Author(s) 2021. Published by Oxford University Press on behalf of the European Society of Cardiology.
PY - 2021/6/7
Y1 - 2021/6/7
N2 - AIMS: This study was performed to develop and externally validate prediction models for appropriate implantable cardioverter-defibrillator (ICD) shock and mortality to identify subgroups with insufficient benefit from ICD implantation.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.
AB - AIMS: This study was performed to develop and externally validate prediction models for appropriate implantable cardioverter-defibrillator (ICD) shock and mortality to identify subgroups with insufficient benefit from ICD implantation.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.
KW - Implantable cardioverter-defibrillator
KW - Mortality
KW - Prediction models
KW - Primary prevention
KW - Risk factors
KW - Sudden cardiac death
UR - http://www.scopus.com/inward/record.url?scp=85104331817&partnerID=8YFLogxK
U2 - 10.1093/europace/euab012
DO - 10.1093/europace/euab012
M3 - Article
C2 - 33582797
SN - 1099-5129
VL - 23
SP - 887
EP - 897
JO - Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology
JF - Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology
IS - 6
ER -