Yiyi Zhang1, Eliseo Guallar1, Elena Blasco-Colmenares2, Darshan Dalal2, Barbara Butcher2, Sanaz Norgard2, Fleur V Y Tjong3, Zayd Eldadah4, Timm Dickfeld5, Kenneth A Ellenbogen6, Joseph E Marine2, Gordon F Tomaselli2, Alan Cheng7. 1. Departments of Epidemiology and Medicine, and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Bloomberg School of Public Health. 2. Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland. 3. AMC Heart Centre, Department of Clinical and Experimental Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. 4. Washington Hospital Center, Washington, DC. 5. University of Maryland, Baltimore, Maryland. 6. Medical College of Virginia, Richmond, Virginia. 7. Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland. Electronic address: alcheng@jhmi.edu.
Abstract
BACKGROUND: Implantable cardioverter-defibrillator (ICD) implantation is contraindicated in those with <1-year life expectancy. OBJECTIVES: The aim of this study was to develop a risk prediction score for 1-year mortality in patients with primary prevention ICDs and to determine the incremental improvement in discrimination when serum-based biomarkers are added to traditional clinical variables. METHODS: We analyzed data from the Prospective Observational Study of Implantable Cardioverter-Defibrillators, a large prospective observational study of patients undergoing primary prevention ICD implantation who were extensively phenotyped for clinical and serum-based biomarkers. We identified variables predicting 1-year mortality and synthesized them into a comprehensive risk scoring construct using backward selection. RESULTS: Of 1189 patients deemed by their treating physicians as having a reasonable 1-year life expectancy, 62 (5.2%) patients died within 1 year of ICD implantation. The risk score, composed of 6 clinical factors (age ≥75 years, New York Heart Association class III/IV, atrial fibrillation, estimated glomerular filtration rate <30 mL/min/1.73 m(2), diabetes, and use of diuretics), had good discrimination (area under the curve 0.77) for 1-year mortality. Addition of 3 biomarkers (tumor necrosis factor α receptor II, pro-brain natriuretic peptide, and cardiac troponin T) further improved model discrimination to 0.82. Patients with 0-1, 2-3, 4-6, or 7-9 risk factors had 1-year mortality rates of 0.8%, 2.7%, 16.1%, and 46.2%, respectively. CONCLUSION: Individuals with more comorbidities and elevation of specific serum biomarkers were at increased risk of all-cause mortality despite being deemed as having a reasonable 1-year life expectancy. A simple risk score composed of readily available clinical data and serum biomarkers may better identify patients at high risk of early mortality and improve patient selection and counseling for primary prevention ICD therapy.
BACKGROUND: Implantable cardioverter-defibrillator (ICD) implantation is contraindicated in those with <1-year life expectancy. OBJECTIVES: The aim of this study was to develop a risk prediction score for 1-year mortality in patients with primary prevention ICDs and to determine the incremental improvement in discrimination when serum-based biomarkers are added to traditional clinical variables. METHODS: We analyzed data from the Prospective Observational Study of Implantable Cardioverter-Defibrillators, a large prospective observational study of patients undergoing primary prevention ICD implantation who were extensively phenotyped for clinical and serum-based biomarkers. We identified variables predicting 1-year mortality and synthesized them into a comprehensive risk scoring construct using backward selection. RESULTS: Of 1189 patients deemed by their treating physicians as having a reasonable 1-year life expectancy, 62 (5.2%) patients died within 1 year of ICD implantation. The risk score, composed of 6 clinical factors (age ≥75 years, New York Heart Association class III/IV, atrial fibrillation, estimated glomerular filtration rate <30 mL/min/1.73 m(2), diabetes, and use of diuretics), had good discrimination (area under the curve 0.77) for 1-year mortality. Addition of 3 biomarkers (tumor necrosis factor α receptor II, pro-brain natriuretic peptide, and cardiac troponin T) further improved model discrimination to 0.82. Patients with 0-1, 2-3, 4-6, or 7-9 risk factors had 1-year mortality rates of 0.8%, 2.7%, 16.1%, and 46.2%, respectively. CONCLUSION: Individuals with more comorbidities and elevation of specific serum biomarkers were at increased risk of all-cause mortality despite being deemed as having a reasonable 1-year life expectancy. A simple risk score composed of readily available clinical data and serum biomarkers may better identify patients at high risk of early mortality and improve patient selection and counseling for primary prevention ICD therapy.
Authors: Michael P Hudson; Christopher M O'Connor; Wendy A Gattis; Gudaye Tasissa; Vic Hasselblad; Cathy M Holleman; Laura H Gaulden; Frank Sedor; E Magnus Ohman Journal: Am Heart J Date: 2004-03 Impact factor: 4.749
Authors: Drew Ertel; Kavita Phatak; Kevin Makati; Marian Holland; Sara Baig; Michael H Kim; Mark Link; Rod Passman Journal: Pacing Clin Electrophysiol Date: 2010-03-08 Impact factor: 1.976
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: K Maeda; T Tsutamoto; A Wada; N Mabuchi; M Hayashi; T Tsutsui; M Ohnishi; M Sawaki; M Fujii; T Matsumoto; M Kinoshita Journal: J Am Coll Cardiol Date: 2000-11-01 Impact factor: 24.094
Authors: Casey S Hager; Sunil Jain; Jeffry Blackwell; Benjamin Culp; Juhee Song; Christopher D Chiles Journal: Am J Cardiol Date: 2010-11-01 Impact factor: 2.778
Authors: Alan Kadish; Alan Dyer; James P Daubert; Rebecca Quigg; N A Mark Estes; Kelley P Anderson; Hugh Calkins; David Hoch; Jeffrey Goldberger; Alaa Shalaby; William E Sanders; Andi Schaechter; Joseph H Levine Journal: N Engl J Med Date: 2004-05-20 Impact factor: 91.245
Authors: Daniel J Friedman; Sana M Al-Khatib; Emily P Zeitler; JooYoon Han; Gust H Bardy; Jeanne E Poole; J Thomas Bigger; Alfred E Buxton; Arthur J Moss; Kerry L Lee; Richard Steinman; Paul Dorian; Riccardo Cappato; Alan H Kadish; Peter J Kudenchuk; Daniel B Mark; Lurdes Y T Inoue; Gillian D Sanders Journal: Am Heart J Date: 2017-06-09 Impact factor: 4.749
Authors: Albert J Rogers; Anojan Selvalingam; Mahmood I Alhusseini; David E Krummen; Cesare Corrado; Firas Abuzaid; Tina Baykaner; Christian Meyer; Paul Clopton; Wayne Giles; Peter Bailis; Steven Niederer; Paul J Wang; Wouter-Jan Rappel; Matei Zaharia; Sanjiv M Narayan Journal: Circ Res Date: 2020-11-10 Impact factor: 17.367
Authors: Marcello Disertori; Michele M Gulizia; Giancarlo Casolo; Pietro Delise; Andrea Di Lenarda; Giuseppe Di Tano; Maurizio Lunati; Luisa Mestroni; Jorge Salerno-Uriarte; Luigi Tavazzi Journal: J Cardiovasc Med (Hagerstown) Date: 2016-04 Impact factor: 2.160