Comparison of Multivariate Risk Estimation Models to Predict Prognosis in Patients With Implantable Cardioverter Defibrillators With or Without Cardiac Resynchronization Therapy

Autor: Salima Akoudad, Beat Schaer, Christian Sticherling, Lara Dabiri Abkenari, Luc Jordaens, Dominic A.M.J. Theuns, Wayne C. Levy
Přispěvatelé: Cardiology
Rok vydání: 2016
Předmět:
Male
medicine.medical_specialty
Multivariate analysis
medicine.medical_treatment
Bundle-Branch Block
Cardiac resynchronization therapy
030204 cardiovascular system & hematology
Implantable defibrillator
Sudden death
Risk Assessment
Cardiac Resynchronization Therapy
03 medical and health sciences
0302 clinical medicine
Internal medicine
medicine
Humans
030212 general & internal medicine
Registries
Netherlands
Proportional Hazards Models
Retrospective Studies
Heart Failure
Framingham Risk Score
business.industry
Proportional hazards model
Stroke Volume
Middle Aged
medicine.disease
Prognosis
Defibrillators
Implantable
Death
Sudden
Cardiac
Heart failure
Multivariate Analysis
Cardiology
Female
Cardiology and Cardiovascular Medicine
business
Multicenter Automatic Defibrillator Implantation Trial
Switzerland
Zdroj: American Journal of Cardiology, 119(9), 1414-1420. Elsevier Inc.
ISSN: 1879-1913
0002-9149
Popis: Several multivariate risk score models were developed to predict prognosis of patients with heart failure (HF). We compared 3 models with regard to prediction of mortality in patients with HF who received an implantable defibrillator (ICD) or a cardiac resynchronization therapy defibrillator (CRT-D), as primary prevention of sudden death. The study cohort consisted of 823 patients (ICD = 410; CRT-D = 413). The evaluated models were the Seattle Heart Failure Model (SHFM), the Multicenter Automatic Defibrillator Implantation Trial II (MADIT II) score, and an adjusted Charlson Comorbidity Index (aCCI). End point was the performance of the models to predict all-cause mortality at 5 years. This was determined by c-statistics, for both subgroups. Multivariate analysis was used to analyze the relations between the risk score models, their individual components and mortality, and its applicability to the entire population. Cumulative mortality was 4.9% at 1 year and 21.1% at 5 years. Discriminatory power for 5-year mortality was highest for the SHFM (0.73; p 0.001) compared with the MADIT II score and the aCCI for the entire population. SHFM performed better than the MADIT II score for CRT-D group. In the entire population, the SHFM and the aCCI were significant predictors of mortality in multivariate analysis (hazard ratio 1.90, 95% confidence interval 1.49 to 2.43 vs hazard ratio 1.11, 95% confidence interval 1.01 to 1.22). The strongest individual components were age, HF, impaired renal function, and cancer, whereas CRT-D use was no predictor. In conclusion, the SHFM has the best discriminatory power for 5-year mortality in patients with HF with an ICD or CRT-D. The aCCI and MADIT II scores are less powerful but viable alternatives.
Databáze: OpenAIRE
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