Roman Nevzorov1, Ilan Goldenberg2, Yuval Konstantino3, Gregory Golovchiner4, Boris Strasberg4, Mahmoud Souleiman5, Vladimir Khalameizer1, Shlomit Ben-Zvi6, Ron Sela7, Shimon Rosenheck8, Nahum A Freedberg9, Michael Geist10, Michal Einhorn Cohen2, Tal Cohen2, Nir Shlomo2, Natalie Gabrielov-Yusim2, Diklah Geva2, Michael Glikson11, Moti Haim3. 1. Electrophysiology and Pacing Unit and ICCU, Barzilai University Medical Center, Ashkelon, Affiliated with Ben-Gurion University of the Negev, Beer Sheva, Israel. 2. Leviev Heart Center, Chaim Sheba Medical Center, Affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. 3. Electrophysiology and Pacing Unit, Soroka University Medical Center, Beer Sheva, Affiliated with Ben-Gurion University of the Negev, Beer Sheva, Israel. 4. Electrophysiology and Pacing Unit, Rabin Medical Center, Petah Tikva, Affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. 5. Electrophysiology and Pacing Unit, Rambam Health Care Campus, Affiliated with the Rappaport Faculty of Medicine, Technion, Haifa, Israel. 6. Electrophysiology and Pacing Unit, Chaim Sheba Medical Center, Affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. 7. Electrophysiology and Pacing Unit, Galilee Medical Center, Affiliated with the Bar Ilan University Faculty of Medicine, Tel Aviv, Israel. 8. Electrophysiology and Pacing Unit, Meir Medical Center, Affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. 9. Electrophysiology and Pacing Unit, HaEmek Medical Center, Afula, Affiliated with the Rappaport Faculty of Medicine, Technion, Haifa, Israel. 10. Electrophysiology and Pacing Unit, Edith Wolfson Hospital, Affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. 11. Electrophysiology and Pacing Unit, Shaare Zedek Medical Center, Affiliated with Hebrow University of Jerusalem, Tel Aviv, Israel.
Abstract
INTRODUCTION: Life expectancy of less than 1 year is usually a contraindication for implantable cardioverter defibrillator (ICD) implantation. The aim was to identify patients at risk of death during the first year after implantation. METHODS AND RESULTS: Data were derived from a prospective Israeli ICD Registry. Two groups of patients were compared, those who died and those who were alive 1 year after ICD implantation. Factors associated with 1-year mortality were identified on a derivation cohort. A risk score was established and validated. A total of 2617 patients have completed 1 year of follow-up after ICD or cardiac resynchronization therapy defibrillator (CRT-D) implantation. Age greater than 75 years (hazard ratio [HR], 2.7; 95% confidence interval [95% CI], 1.6 to 4.4), atrial fibrillation (AF; HR, 1.9; 95% CI, 1.12 to 3.17), chronic lung disease (HR, 2.0; 95% CI, 1.1 to 3.76), anemia (HR, 2.3; 95% CI, 1.3 to 3.93) and chronic renal failure (CRF; HR, 3.4; 95% CI, 1.74 to 6.6) were independent risk factors for 1-year mortality. We propose a simple AAACC ("triple A double C") score for prediction of 1-year mortality after ICD implantation: Age greater than 75 years (3 points(pts)), anemia (2 pts), AF (1 pt), CRF (3 pts) and chronic lung disease (1 pt). Mortality risk increased with rising number of points (from 1% with 0 pts to 12.5% with >4 pts). The risk score was evaluated with receiver operating characteristic curve and the area under the curve of the validation curve is 0.71 (95% CI, 0.66 to 0.76). CONCLUSIONS: Age greater than 75, AF, chronic lung disease, anemia, and CRF were independent risk factors for 1-year mortality. AAACC risk score identifies patients at high risk of death during 1 year after ICD implantation.
INTRODUCTION: Life expectancy of less than 1 year is usually a contraindication for implantable cardioverter defibrillator (ICD) implantation. The aim was to identify patients at risk of death during the first year after implantation. METHODS AND RESULTS: Data were derived from a prospective Israeli ICD Registry. Two groups of patients were compared, those who died and those who were alive 1 year after ICD implantation. Factors associated with 1-year mortality were identified on a derivation cohort. A risk score was established and validated. A total of 2617 patients have completed 1 year of follow-up after ICD or cardiac resynchronization therapy defibrillator (CRT-D) implantation. Age greater than 75 years (hazard ratio [HR], 2.7; 95% confidence interval [95% CI], 1.6 to 4.4), atrial fibrillation (AF; HR, 1.9; 95% CI, 1.12 to 3.17), chronic lung disease (HR, 2.0; 95% CI, 1.1 to 3.76), anemia (HR, 2.3; 95% CI, 1.3 to 3.93) and chronic renal failure (CRF; HR, 3.4; 95% CI, 1.74 to 6.6) were independent risk factors for 1-year mortality. We propose a simple AAACC ("triple A double C") score for prediction of 1-year mortality after ICD implantation: Age greater than 75 years (3 points(pts)), anemia (2 pts), AF (1 pt), CRF (3 pts) and chronic lung disease (1 pt). Mortality risk increased with rising number of points (from 1% with 0 pts to 12.5% with >4 pts). The risk score was evaluated with receiver operating characteristic curve and the area under the curve of the validation curve is 0.71 (95% CI, 0.66 to 0.76). CONCLUSIONS: Age greater than 75, AF, chronic lung disease, anemia, and CRF were independent risk factors for 1-year mortality. AAACC risk score identifies patients at high risk of death during 1 year after ICD implantation.