OBJECTIVES: We explored the association between renal insufficiency (RI) and mortality among patients treated with animplantable cardioverter defibrillator (ICD). BACKGROUND: Randomized trials have shown improvements in survival among select patients treated with an ICD. Renal insufficiency patients have a high risk of cardiac death; however, it is not clear whether the ICD has a positive effect on survival in this group of patients. METHODS: This was a retrospective review of a single-center experience of 346 patients treated with an ICD. Patients were stratified into 4 groups according to their glomerular filtration rate (eGFR; expressed as mL/min/ -1.73 m(2)) at implantation: group I, > 75.0; group II, - 60.0 to 74.9; group III, - 45.0 to 59.9; and group IV, - < or = 45.0. All-cause mortality was the primary end point, with differences in survival times among the 4 groups of patients expressed in Kaplan-Meier curves. RESULTS: Mean follow-up was 3.5 y (range 0.1 to 12.9 y), during which 67 patients died (19%). Mortality in each eGFR group was: I - 6.8%, II - 13.8%, III - 11.5%, IV - 45.8% (p < 0.001). Survival times (mean, y) were I, 3.74; II, 3.66; III, 3.38, and IV, 2.82. The presence of diabetes was not a factor in the outcomes. CONCLUSIONS:Patients treated with an ICD with an eGFR of < or = 45.0 mL/min/1.73 m(2) have a significantly shorter survival time than those patients with an eGFR > 45.0 mL/min/1.73 m(2). Patients with an eGFR > 45.0 mL/min/1.73 m(2) appear to have equally good outcomes when treated with an ICD. This may have implications for patient selection for ICD therapy.
RCT Entities:
OBJECTIVES: We explored the association between renal insufficiency (RI) and mortality among patients treated with an implantable cardioverter defibrillator (ICD). BACKGROUND: Randomized trials have shown improvements in survival among select patients treated with an ICD. Renal insufficiencypatients have a high risk of cardiac death; however, it is not clear whether the ICD has a positive effect on survival in this group of patients. METHODS: This was a retrospective review of a single-center experience of 346 patients treated with an ICD. Patients were stratified into 4 groups according to their glomerular filtration rate (eGFR; expressed as mL/min/ -1.73 m(2)) at implantation: group I, > 75.0; group II, - 60.0 to 74.9; group III, - 45.0 to 59.9; and group IV, - < or = 45.0. All-cause mortality was the primary end point, with differences in survival times among the 4 groups of patients expressed in Kaplan-Meier curves. RESULTS: Mean follow-up was 3.5 y (range 0.1 to 12.9 y), during which 67 patients died (19%). Mortality in each eGFR group was: I - 6.8%, II - 13.8%, III - 11.5%, IV - 45.8% (p < 0.001). Survival times (mean, y) were I, 3.74; II, 3.66; III, 3.38, and IV, 2.82. The presence of diabetes was not a factor in the outcomes. CONCLUSIONS:Patients treated with an ICD with an eGFR of < or = 45.0 mL/min/1.73 m(2) have a significantly shorter survival time than those patients with an eGFR > 45.0 mL/min/1.73 m(2). Patients with an eGFR > 45.0 mL/min/1.73 m(2) appear to have equally good outcomes when treated with an ICD. This may have implications for patient selection for ICD therapy.
Authors: Gabriel Gregoratos; Jonathan Abrams; Andrew E Epstein; Roger A Freedman; David L Hayes; Mark A Hlatky; Richard E Kerber; Gerald V Naccarelli; Mark H Schoenfeld; Michael J Silka; Stephen L Winters Journal: J Am Coll Cardiol Date: 2002-11-06 Impact factor: 24.094
Authors: Michael R Bristow; Leslie A Saxon; John Boehmer; Steven Krueger; David A Kass; Teresa De Marco; Peter Carson; Lorenzo DiCarlo; David DeMets; Bill G White; Dale W DeVries; Arthur M Feldman Journal: N Engl J Med Date: 2004-05-20 Impact factor: 91.245
Authors: Arthur J Moss; Wojciech Zareba; W Jackson Hall; Helmut Klein; David J Wilber; David S Cannom; James P Daubert; Steven L Higgins; Mary W Brown; Mark L Andrews Journal: N Engl J Med Date: 2002-03-19 Impact factor: 91.245
Authors: Nagesh S Anavekar; John J V McMurray; Eric J Velazquez; Scott D Solomon; Lars Kober; Jean-Lucien Rouleau; Harvey D White; Rolf Nordlander; Aldo Maggioni; Kenneth Dickstein; Steven Zelenkofske; Jeffrey D Leimberger; Robert M Califf; Marc A Pfeffer Journal: N Engl J Med Date: 2004-09-23 Impact factor: 91.245
Authors: Paul L Hess; Anne S Hellkamp; Eric D Peterson; Gillian D Sanders; Hussein R Al-Khalidi; Lesley H Curtis; Bradley G Hammill; Patrick H Pun; Jeptha P Curtis; Kevin J Anstrom; Stephen C Hammill; Sana M Al-Khatib Journal: Circ Arrhythm Electrophysiol Date: 2014-07-18