Eligibility and utilization of implantable cardioverter-defibrillators in a regional STEMI system

Johnson, Benjamin K.; Garberich, Ross; Henry, Timothy D.; Katsiyiannis, William T.; Sengupta, Jay; Kalra, Ankur; Hauser, Robert G.; Lardy, Meghan; Newell, Marc C.

doi:10.1016/j.hrthm.2015.10.019

Cited by 2 publications

(2 citation statements)

References 19 publications

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“…The addition of a coefficient for ICD therapy improved model calibration in the ICD arm, correcting for the near-absence of this evidence-based therapy in the derivation cohort. Several studies have documented that less than 50% of eligible patients receive a primary prevention ICD 29-31 . The Tufts MC HF Risk Model includes a variable for ICD use, derived by recalibrating the model using the SCD-HeFT cohort, and thus can be used in patients with or without an ICD, although the performance of the updated model with a variable for ICD use requires additional external validation.…”

Section: Discussionmentioning

confidence: 99%

Multistate Model to Predict Heart Failure Hospitalizations and All-Cause Mortality in Outpatients With Heart Failure With Reduced Ejection Fraction

Upshaw

Konstam

Klaveren

et al. 2016

Circ: Heart Failure

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Background Outpatients with heart failure (HF) who are at high risk for HF hospitalization and/or death may benefit from early identification. We sought to develop and externally validate a model to predict both HF hospitalization and mortality that accounts for the semi-competing nature of the two outcomes and captures the risk associated with the transition from the stable outpatient state to the post-HF hospitalization state. Methods and Results A multi-state model to predict HF hospitalization and all-cause mortality was derived using data (n=3834) from the Heart Failure Endpoint evaluation of Angiotensin II Antagonist Losartan (HEAAL) study, a multinational randomized trial in symptomatic patients with reduced left ventricular ejection fraction. Twelve easily and reliably obtainable demographic and clinical predictors were pre-specified for model inclusion. Model performance was assessed in the Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT) cohort (n=2521). At one year, the probability of being alive without HF hospitalization was 94% for a typical patient in the lowest risk quintile and 77% for a typical patient in the highest risk quintile and this variability in risk continued through 7 years of follow up. The model c-index was 0.72 in the derivation cohort, 0.66 in the validation cohort and 0.69 in the implantable cardiac defibrillator arm of the validation cohort. There was excellent calibration across quintiles of predicted risk. Conclusions Our findings illustrate the advantages of a multi-state modeling approach - providing estimates of HF hospitalization and death in the same model, comparison of predictors for the different outcomes and demonstrating the different trajectories of patients based on baseline characteristics and intermediary events.

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Section: Discussionmentioning

confidence: 99%

Multistate Model to Predict Heart Failure Hospitalizations and All-Cause Mortality in Outpatients With Heart Failure With Reduced Ejection Fraction

Upshaw

Konstam

Klaveren

et al. 2016

Circ: Heart Failure

View full text Add to dashboard Cite

show abstract

“…Patients with ischemic cardiomyopathy are at a higher risk of sudden cardiac death (SCD) due to ventricular arrhythmias, and current guidelines recommend an implantable cardioverter-defibrillator (ICD) to reduce mortality in patients with coronary artery disease and reduced left ventricular ejection fraction (LVEF 35%). [1][2][3] This recommendation derives from two trials, namely the MADIT-II (Multicenter Automatic Defibrillator Implantation Trial II) 4 and the SCD-HeFT (Sudden Cardiac Death in Heart Failure Trial), 5 which demonstrated the benefit of ICD compared with conventional medical therapy alone. In contrast, in the DINAMIT (Defibrillator in Acute Myocardial Infarction Trial) 6 and IRIS (Immediate Risk-Stratification Improves Survival) 7 trials, overall mortality was not reduced by early ICD implantation in patients with myocardial infarction and reduced LVEF.…”

Section: Introductionmentioning

confidence: 99%

Implantable-cardioverter-defibrillator after ST-elevation myocardial infarction: when and how frequently is it implanted and what is the rate of appropriate interventions? Insight from Trieste registry

Pezzato,

Fabris,

Gregorio

et al. 2023

Journal of Cardiovascular Medicine

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Background There are limited data on implantable-cardioverter-defibrillator (ICD) implantation after ST-elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (pPCI). Therefore, we evaluated when and how frequently an ICD is implanted after pPCI, the rate of appropriate ICD interventions, and predictors of ICD implantation. Methods We analyzed STEMI patients treated with pPCI at the University Hospital of Trieste, Italy, between January 2010 and December 2019. We cross-matched patients’ data with those present in the Trieste ICD registry. Results Among 1805 consecutive patients treated with pPCI, 3.6% underwent ICD implantation during a median follow-up of 6.7 [interquartile range (IQR) 4.3–9.2] years. At 12 months, the mean number of ICD implantations was 2.3/100 patients [95% confidence interval (95% CI) 1.7–3.1] and remained stable over time (at 24 months: 2.5/100 patients, 95% CI 2.0–3.5 and at 36 months: 2.6/100 patients, 95% CI 2.3–3.8); 83.1% of ICDs were implanted for primary prevention, and more than half (55%) were implanted in patients with ejection fraction more than 35% at the moment of STEMI discharge. The rate of appropriate ICD interventions was 16.9% at a median follow-up of 5.7 years (IQR 3.3–8.3 years) after ICD implantation. At 12 months, the mean number of appropriate ICD interventions was 5/100 patients and 7/100 patients after 24 months. In patients with ejection fraction more than 35% at STEMI discharge (median ejection fraction 43%; IQR 40–48), independent predictors of ICD implantation were male sex, anterior STEMI and troponin peak more than 100 000 ng/dl. Conclusion The rate of ICD implantations after pPCI is low; however, the rate of appropriate ICD interventions is high. A relevant subgroup of patients received ICD implantations at follow-up despite a nonsevere ejection fraction at discharge after STEMI. Among these patients, those with high troponin release deserve strict follow-up and full optimal medical treatment.

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Eligibility and utilization of implantable cardioverter-defibrillators in a regional STEMI system

Cited by 2 publications

References 19 publications

Multistate Model to Predict Heart Failure Hospitalizations and All-Cause Mortality in Outpatients With Heart Failure With Reduced Ejection Fraction

Multistate Model to Predict Heart Failure Hospitalizations and All-Cause Mortality in Outpatients With Heart Failure With Reduced Ejection Fraction

Implantable-cardioverter-defibrillator after ST-elevation myocardial infarction: when and how frequently is it implanted and what is the rate of appropriate interventions? Insight from Trieste registry

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