Renal disease and cardiac mortality in survivors of sudden cardiac death.
OBJECTIVE
Renal disease is associated with increased all-cause mortality and cardiovascular mortality. However, the role of ICD implantation on cardiac mortality in patients with renal disease has not been well studied. Implantable cardioverter-defibrillator (ICD) implantation is protective against cardiac death in a secondary prevention population with renal disease.


METHODS
The Antiarrhythmics Versus Implantable Cardioverter Defibrillators (AVID) Trial (n = 1016) was a multicentre trial comparing ICD (n = 507) and anti-arrhythmic drugs (AAD) (n = 509) for secondary prevention of life-threatening ventricular tachyarrhythmias. We performed a post-hoc analysis of the AVID trial using the National Heart, Lung, and Blood Institute limited access dataset. Individuals in the original AVID study with history of renal disease (n = 82) were included in this analysis. Outcomes of our analysis were cardiac death and all-cause mortality.


RESULTS
41 patients had renal disease in both the ICD and AAD arms. A total of 116 patients died in the ICD arm, while 162 died in the AAD arm. Renal disease was an independent predictor (HR, 95% CI) of cardiac death (1.967, 1.09-3.57, P = 0.02) and all-cause mortality (2.04, 1.23-3.39, P = 0.01) in the AAD arm. Renal disease was also a predictor of all-cause mortality in the ICD arm (1.75, 1.01-3.01, P = 0.04). However, renal disease did not influence cardiac death in the ICD arm.


CONCLUSIONS
Our study investigates the effect of ICD implantation in an entirely secondary prevention population with renal disease. ICD implantation appears to be equally protective against cardiac death in renal disease when compared to AAD.
Rathod
Ankit
A
Division of Cardiology, Department of Internal Medicine, Wayne State University, Detroit, MI 48201, USA.
Badheka
Apurva
A
Kizilbash
Mohammad
M
Manickam
Palaniappan
P
Mohamad
Tamam
T
Bhat
Samrat
S
Afonso
Luis
L
Jacob
Sony
S
D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use*; D001145:Arrhythmias, Cardiac / Q000188:drug therapy / Q000401:mortality* / Q000628:therapy*; D002423:Cause of Death; D016009:Chi-Square Distribution; D017147:Defibrillators, Implantable; D005260:Female; D006801:Humans; D007674:Kidney Diseases / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D016016:Proportional Hazards Models; D016032:Randomized Controlled Trials as Topic; D017741:Survivors
D000889:Anti-Arrhythmia Agents