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Article Dans Une Revue Journal of the American College of Cardiology Année : 2017

Outcomes in Guideline-Based Versus Off-Guideline Primary Prevention Implantable Cardioverter-Defibrillator Recipients

Résumé

In the setting of primary prevention of sudden cardiac death, international guidelines (1) recommend an implantable cardioverter-defibrillator (ICD) for symptomatic patients (New York Heart Association [NYHA] functional class II or III) with altered left ventricular ejection fraction (LVEF) (#35%). Our objective was to compare outcomes among patients implanted with a primary prevention ICD according to whether the implantations were guideline-based or not. The DAI-PP (Primary Prevention ICD French Registry) (NCT01992458) enrolled all consecutive patients with ischemic or dilated cardiomyopathy implanted with a primary prevention ICD in 12 French centers between 2002 and 2012 (2). On-guideline patients met both basic criteria, namely, LVEF #35% and NYHA functional class II to III. Off-guideline patients did not meet at least 1 of the 2 criteria. We focused on candidates without an indication for cardiac resynchronization therapy. Vital status and causes of death were ascertained by review of hospital medical files or by communication with primary care physicians, and were corroborated with the French vital status database of the National Institute of Economic Statistics and the French Center on Medical Causes of Death. ICD programming was nonstandardized, although there was a broad consensus between centers (all except 1) concerning the use of high ventricular rates and usually 2 zones (typically ventricular tachycardia >180 beats/min, ventricular fibrillation >220 beats/ min). All data were analyzed using the SAS program version 9.4 (SAS Institute, Cary, North Carolina). Of a total of 5,539 patients enrolled in DAI-PP study, 2,538 were implanted with a single-or double-chamber ICD. Mean age was 60.2 AE 11.7 years, 1,694 (87.4%) were men, 1,379 (71.9%) had ischemic car-diomyopathy, mean LVEF was 28.2 AE 8.6%, and 853 (59.3%) had a QRS width <120 ms. Guideline eligibility for implantation could be eventually ascertained in 1,939 patients (76.4%). Overall, 500 patients (25.8%) were identified to be implanted off-guideline, with a mean LVEF about 33.8 AE 12.7% and with 418 (83.6%) having an NYHA functional class I or IV. We observed no significant intergroup differences in age, sex, type of cardiomyopathy, type of ICD, and sinus rhythm. Over time, the proportion of off-guideline patients remained unchanged (p ¼ 0.48). On-guideline patients had a sicker clinical profile with a lower mean LVEF (26.3 AE 5.4% vs. 33.8 AE 12.7% for on-guideline vs. off-guideline patients, respectively;

Dates et versions

hal-01760755 , version 1 (22-05-2018)

Identifiants

Citer

William Escande, Serge Boveda, Pascal Defaye, Christophe Leclercq, Nicolas Sadoul, et al.. Outcomes in Guideline-Based Versus Off-Guideline Primary Prevention Implantable Cardioverter-Defibrillator Recipients. Journal of the American College of Cardiology, 2017, 70 (10), pp.1302 - 1303. ⟨10.1016/j.jacc.2017.07.711⟩. ⟨hal-01760755⟩
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