Development and external validation of prediction models to predict implantable cardioverter-defibrillator efficacy in primary prevention of sudden cardiac death
EP Europace, vol. 23, pp. 887–897
Abstract
AIMS: This study was performed to develop and externally validate prediction models for appropriate implantable cardioverter-defibrillator (ICD) shock and mortality to identify subgroups with insufficient benefit from ICD implantation. METHODS AND RESULTS: We recruited patients scheduled for primary prevention ICD implantation and reduced left ventricular function. Bootstrapping-based Cox proportional hazards and Fine and Gray competing risk models with likely candidate predictors were developed for all-cause mortality and appropriate ICD shock, respectively. Between 2014 and 2018, we included 1441 consecutive patients in the development and 1450 patients in the validation cohort. During a median follow-up of 2.4 (IQR 2.1-2.8) years, 109 (7.6%) patients received appropriate ICD shock and 193 (13.4%) died in the development cohort. During a median follow-up of 2.7 (IQR 2.0-3.4) years, 105 (7.2%) received appropriate ICD shock and 223 (15.4%) died in the validation cohort. Selected predictors of appropriate ICD shock were gender, NSVT, ACE/ARB use, atrial fibrillation history, Aldosterone-antagonist use, Digoxin use, eGFR, (N)OAC use, and peripheral vascular disease. Selected predictors of all-cause mortality were age, diuretic use, sodium, NT-pro-BNP, and ACE/ARB use. C-statistic was 0.61 and 0.60 at respectively internal and external validation for appropriate ICD shock and 0.74 at both internal and external validation for mortality. CONCLUSION: Although this cohort study was specifically designed to develop prediction models, risk stratification still remains challenging and no large group with insufficient benefit of ICD implantation was found. However, the prediction models have some clinical utility as we present several scenarios where ICD implantation might be postponed.
Authors 43
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Tom E. Verstraelen corresponding
Amsterdam UMC Location University of Amsterdam · Amsterdam University Medical Centers · University of Amsterdam
Affiliation as printed
Department of Cardiology, Amsterdam UMC, Location AMC, University of Amsterdam, Heart Center, Amsterdam, the Netherlands
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Marit van Barreveld corresponding
Amsterdam UMC Location University of Amsterdam · Amsterdam University Medical Centers · University of Amsterdam
Affiliation as printed
Department of Cardiology, Amsterdam UMC, Location AMC, University of Amsterdam, Heart Center, Amsterdam, the Netherlands
Department of Clinical Epidemiology, Biostatistics and Bio-informatics, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, the Netherlands
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Affiliation as printed
Department of Cardiology, Thorax Center Twente, Medisch Spectrum Twente, Enschede, the Netherlands
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Amsterdam UMC Location University of Amsterdam · St. Antonius Ziekenhuis · Amsterdam University Medical Centers · University of Amsterdam
Affiliation as printed
Cardiology Department, St. Antonius Ziekenhuis Nieuwegein, the Netherlands
Department of Cardiology, Amsterdam UMC, Location AMC, University of Amsterdam, Heart Center, Amsterdam, the Netherlands
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Affiliation as printed
Department of Cardiology, Isala Klinieken, Zwolle, the Netherlands
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University Medical Center Utrecht
Affiliation as printed
Division of Heart and Lungs, Department of Cardiology, University Medical Centre, Utrecht, the Netherlands
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Affiliation as printed
Department of Cardiology, Erasmus MC, Rotterdam, the Netherlands
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Affiliation as printed
Department of Cardiology, Catharina Ziekenhuis Eindhoven, Eindhoven, the Netherlands
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Affiliation as printed
Department of Cardiology, Noordwest Ziekenhuisgroep, Alkmaar, the Netherlands
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University Medical Center Groningen
Affiliation as printed
Department of Epidemiology, University Medical Centre Groningen, Groningen, the Netherlands
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Amsterdam UMC Location University of Amsterdam · Amsterdam University Medical Centers · University of Amsterdam
Affiliation as printed
Department of Cardiology, Amsterdam UMC, Location AMC, University of Amsterdam, Heart Center, Amsterdam, the Netherlands
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Vrije Universiteit Amsterdam · Amsterdam UMC Location Vrije Universiteit Amsterdam
Affiliation as printed
Department of Cardiology, Amsterdam UMC, Location VUMC, Vrije Universiteit, Amsterdam, The Netherlands
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Affiliation as printed
Department of Cardiology, Amphia Hospitals, Breda, the Netherlands
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Affiliation as printed
Department of Cardiology, Thorax Center Twente, Medisch Spectrum Twente, Enschede, the Netherlands
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University Medical Center Utrecht
Affiliation as printed
Division of Heart and Lungs, Department of Cardiology, University Medical Centre, Utrecht, the Netherlands
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Affiliation as printed
Department of Cardiology, Haga hospitals, the Hague, the Netherlands
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University Medical Center Groningen · University of Groningen
Affiliation as printed
Department of Cardiology, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
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Affiliation as printed
Department of Cardiology, Maasstad hospital, Rotterdam, the Netherlands
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Elisabeth-TweeSteden Ziekenhuis
Affiliation as printed
Department of Cardiology, Elisabeth Tweesteden Hospital Tilburg, Tilburg, the Netherlands
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Canisius-Wilhelmina Ziekenhuis
Affiliation as printed
Department of Cardiology, Canisius Wilhelmina hospital, Nijmegen, the Netherlands
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Affiliation as printed
Department of Cardiology, Albert Schweitzer Hospital, Dordrecht, the Netherlands
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Affiliation as printed
Department of Cardiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands
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Maastricht University Medical Centre · Maastricht University
Affiliation as printed
Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center (MUMC+), Maastricht, the Netherlands
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Medisch Centrum Haaglanden · Stichting Haaglanden Medisch Centrum
Affiliation as printed
Department of Cardiology, Haaglanden Medical Center, The Hague, the Netherlands
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Affiliation as printed
Department of Cardiology, Spaarne Gasthuis, Haarlem, the Netherlands
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Leiden University Medical Center
Affiliation as printed
Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
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Affiliation as printed
Department of Cardiology, Sint Franciscus Vlietland Group, Schiedam, the Netherlands
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Radboud University Medical Center
Affiliation as printed
Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands
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Affiliation as printed
Department of Cardiology, Martini hospital, Groningen, the Netherlands
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Affiliation as printed
Department of Cardiology, Flevo Hospital, Almere, the Netherlands
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Affiliation as printed
Department of Cardiology, Medical Center Leeuwarden, Leeuwarden, the Netherlands
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Affiliation as printed
Department of Cardiology, Scheper Hospital, Emmen, the Netherlands
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Affiliation as printed
Department of Cardiology, Rijnstate Hospital, Arnhem, the Netherlands
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Amsterdam UMC Location University of Amsterdam · Amsterdam University Medical Centers · University of Amsterdam
Affiliation as printed
Department of Cardiology, Amsterdam UMC, Location AMC, University of Amsterdam, Heart Center, Amsterdam, the Netherlands
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Affiliation as printed
Department of Cardiology, Catharina Ziekenhuis Eindhoven, Eindhoven, the Netherlands
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Universitätsmedizin Göttingen · German Centre for Cardiovascular Research · University of Göttingen
Affiliation as printed
Department of Medical Statistics, University Medical Center Göttingen, Göttingen, Germany and DZHK (German Center for Cardiovascular Research), Partnersite, Göttingen, Germany
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University of Basel · University Hospital of Basel
Affiliation as printed
Department of Cardiology, University Hospital Basel, University of Basel, Switzerland
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Affiliation as printed
Department of Cardiovascular Sciences, University Hospitals Leuven, University of Leuven, Leuven, Belgium
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Universitätsmedizin Göttingen · German Centre for Cardiovascular Research · University of Göttingen
Affiliation as printed
Department of Medical Statistics, University Medical Center Göttingen, Göttingen, Germany and DZHK (German Center for Cardiovascular Research), Partnersite, Göttingen, Germany
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Universitätsmedizin Göttingen · German Centre for Cardiovascular Research · University of Göttingen
Affiliation as printed
DZHK (German Center for Cardiovascular Research), Partner site, Göttingen, Germany
Department of Cardiology and Pneumology—Heart Center, University of Göttingen Medical Center, Göttingen, Germany
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Amsterdam UMC Location University of Amsterdam · Amsterdam University Medical Centers · University of Amsterdam
Affiliation as printed
Department of Clinical Epidemiology, Biostatistics and Bio-informatics, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, the Netherlands
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Amsterdam UMC Location University of Amsterdam · Amsterdam University Medical Centers · University of Amsterdam
Affiliation as printed
Department of Clinical Epidemiology, Biostatistics and Bio-informatics, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, the Netherlands
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Amsterdam UMC Location University of Amsterdam · Amsterdam University Medical Centers · University of Amsterdam
Affiliation as printed
Department of Cardiology, Amsterdam UMC, Location AMC, University of Amsterdam, Heart Center, Amsterdam, the Netherlands
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