Prognostic value of Charlson Comorbidity Index in the elderly with a cardioverter defibrillator implantation

INTERNATIONAL JOURNAL OF CARDIOLOGY

卷:314

Article

Poupin, Pierre¹  Bouleti, Claire^2,3,4  Degand, Bruno²  Paccalin, Marc^3,5  Le Gal, Francois²  Bureau, Marie-Laure^2,3  Alos, Benjamin^2,3,4  Roumegou, Pierre²  Christiaens, Luc^2,3,4  Ingrand, Pierre^3,6  Garcia, Rodrigue^2,3,4 

[1] CHU Poitiers, Unite Med Chirurg Pole Montmorillon, 2 Rue Miletrie, F-86021 Poitiers, France

[2] CHU Poitiers, Serv Cardiol, 2 Rue Miletrie, F-86021 Poitiers, France

[3] Univ Poitiers, Fac Med & Pharm, F-86021 Poitiers, France

[4] CHU Poitiers, INSERM CIC 1402, 2 Rue Miletrie, F-86021 Poitiers, France

[5] CHU Poitiers, Serv Geriatrie, 2 Rue Miletrie, F-86021 Poitiers, France

[6] CHU Poitiers, Epidemiol & Biostat, INSERM CIC 1402, 2 Rue Miletrie, F-86021 Poitiers, France

关键词: Implantable cardioverter-defibrillator;    Geriatrics;    Sudden death;    Heart failure;    Ventricular tachycardia;    Prevention;   

DOI  :  10.1016/j.ijcard.2020.03.060

来源: Elsevier

【 摘 要 】

Background: Elderly patients are often underrepresented in implantable cardioverter defibrillator (ICD) trials, and ICD implantation in patients =75 years consequently remains controversial. We aimed to evaluatemortality, appropriate ICD therapy rates and survival gain in an elderly population after risk stratification according to the Charlson Comorbidity Index (CCI). Methods: Thismonocentric retrospective study included elderly ICD patients =75 years. Theywere subdivided according to their CCI score into 3 categories (0-1, 2-3 or >= 4 points). Elderly patients were matched 1:2with younger control ICD patients on gender, type of prevention (primary or secondary) and type of device (associated cardiac resynchronization therapy or not). Results: Between January 2009 and July 2017, 121 elderly patients (mean age 78 +/- 3; 83% male) matched with 242 controls (mean age 66 +/- 5) were included. At 5 year follow-up after ICD implantation, overall survival was 78%, 57%, and 29% (P= 0.002) in the elderlywith a CCI score of 0-1, 2-3 and >= 4 respectively, and 72% in controls. There was no significant difference regarding ICD appropriate therapy between the 3 subgroups despite a trend towards lower rates of therapy in CCI >= 4 points patients (34.2%, 39.7% and 22.8% respectively; P= 0.45). Median potential survival gain after an appropriate therapywas >5, 4.7 and 1.4 years, with a CCI score of 0-1, 2-3 and >= 4 respectively (P= 0.01). Conclusion: Elderly patients with CCI score = 4 had the lowest survival after ICD implantation and little survival gain in case of appropriate defibrillator therapy. More than age alone, the burden of comorbidities assessed by the CCI could be helpful to better select elderly patients for ICD implantation. (c) 2020 Elsevier B.V. All rights reserved.

【 授权许可】

Free