Seattle Heart Failure and Proportional Risk Models Predict Benefit From Implantable Cardioverter-Defibrillators

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY

卷:69

Article

Bilchick, Kenneth C.¹  Wang, Yongfei^2,3  Cheng, Alan⁴  Curtis, Jeptha P.^2,3  Dharmarajan, Kumar^2,3  Stukenborg, George J.⁵  Shadman, Ramin⁶  Anand, Inder⁷  Lund, Lars H.⁸  Dahlstroem, Ulf^9,10  Sartipy, Ulrik^11,12  Maggioni, Aldo¹³  Swedberg, Karl^14,15  O'Conner, Chris¹⁶  Levy, Wayne C.¹⁷ 

[1] Univ Virginia Hlth Syst, Dept Med, Charlottesville, VA USA

[2] Yale New Haven Med Ctr, Ctr Outcomes Res & Evaluat, 20 York St, New Haven, CT 06504 USA

[3] Yale Univ, Dept Internal Med, New Haven, CT USA

[4] Johns Hopkins Med Inst, Dept Med, Baltimore, MD 21205 USA

[5] Univ Virginia, Dept Publ Hlth Sci, Charlottesville, VA USA

[6] Southern Calif Permanente Med Grp, Los Angeles, CA USA

[7] Univ Minnesota, Minneapolis, MN USA

[8] Karolinska Univ Hosp, Dept Med Cardiol, Stockholm, Sweden

[9] Linkoping Univ, Dept Cardiol, Linkoping, Sweden

[10] Linkoping Univ, Dept Med & Hlth Sci, Linkoping, Sweden

[11] Karolinska Inst, Dept Mol Med & Surg, Stockholm, Sweden

[12] Karolinska Univ Hosp, Sect Cardiothorac Surg, Stockholm, Sweden

[13] Italian Assoc Hosp Cardiologists, Res Ctr, Florence, Italy

[14] Univ Gothenburg, Sahlgrenska Acad, Dept Clin & Mol Med, Gothenburg, Sweden

[15] Imperial Coll, Natl Heart & Lung Inst, London, England

[16] Inova Healthcare Syst, Fairfax, VA USA

[17] Univ Washington, Dept Med, Seattle, WA USA

关键词: heart failure;    implantable cardioverter-defibrillator;    risk models;   

DOI  :  10.1016/j.jacc.2017.03.568

来源: Elsevier

【 摘 要 】

BACKGROUND Recent clinical trials highlight the need for better models to identify patients at higher risk of sudden death. OBJECTIVES The authors hypothesized that the Seattle Heart Failure Model (SHFM) for overall survival and the Seattle Proportional Risk Model (SPRM) for proportional risk of sudden death, including death from ventricular arrhythmias, would predict the survival benefit with an implantable cardioverter-defibrillator (ICD). METHODS Patients with primary prevention ICDs from the National Cardiovascular Data Registry (NCDR) were compared with control patients with heart failure (HF) without ICDs with respect to 5-year survival using multivariable Cox proportional hazards regression. RESULTS Among 98,846 patients with HF (87,914 with ICDs and 10,932 without ICDs), the SHFM was strongly associated with all-cause mortality (p < 0.0001). The ICD-SPRM interaction was significant (p < 0.0001), such that SPRM quintile 5 patients had approximately twice the reduction in mortality with the ICD versus SPRM quintile 1 patients (adjusted hazard ratios [HR]: 0.602; 95% confidence interval [CI]: 0.537 to 0.675 vs. 0.793; 95% CI: 0.736 to 0.855, respectively). Among patients with SHFM-predicted annual mortality <= 5.7%, those with a SPRM-predicted risk of sudden death below the median had no reduction in mortality with the ICD (adjusted ICD HR: 0.921; 95% CI: 0.787 to 1.08; p = 0.31), whereas those with SPRM above the median derived the greatest benefit (adjusted HR: 0.599; 95% CI: 0.530 to 0.677; p < 0.0001). CONCLUSIONS The SHFM predicted all-cause mortality in a large cohort with and without ICDs, and the SPRM discriminated and calibrated the potential ICD benefit. Together, the models identified patients less likely to derive a survival benefit from primary prevention ICDs. (J Am Coll Cardiol 2017;69:2606-18) (C) 2017 by the American College of Cardiology Foundation.

【 授权许可】

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