title: Peripheral artery disease is an independent predictor of mortality after implantable cardioverter-defibrillator implantation in patients with severe left ventricular dysfunction.
abstract: The impact of peripheral artery disease (PAD) on survival in implantable cardioverter defibrillator (ICD) patients is poorly understood. Thus, we assessed the risk of PAD in our adult ICD patients with left ventricular dysfunction (ejection fraction [EF] ≤35%). Survival was estimated with Kaplan-Meier method and compared by the log-rank test; a Cox proportional hazards model assessed the effects of clinical variables on survival. Average age and EF of 1399 patients were 67.0 ± 12.1 years and 23.8% ± 7.2%, respectively. The ICD patients with PAD had significantly worse survival than those without (unadjusted P < .0001). The multivariate predictors of survival at implant were (hazard ratio, HR [95% confidence interval]) age (HR 1.05 [1.04-1.07] P < .0001), PAD (HR 2.07 [1.53-2.80] P < .0001), class III/IV heart failure (HR 1.36 [1.06-1.76] P = .016), creatinine 1.4-2.0 mg/dL (HR 1.36 [1.05-1.76] P = .019), and creatinine ≥2.0 mg/dL (HR 2.01 [1.42-2.85] P < .0001). The PAD is an independent predictor of mortality and should be considered in the preimplant risk assessment.
authors: Vascular Medicine, Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA nedaa.skeik@allina.com.
authors: Nedaa
authors: N
authors: Skeik
authors: Minneapolis Heart Institute Foundation, Minneapolis, MN, USA.
authors: Deepa M
authors: DM
authors: McGriff
authors: Electrophysiology, Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA.
authors: William T
authors: WT
authors: Katsiyiannis
authors: Vascular Surgery, Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA.
authors: Timothy M
authors: TM
authors: Sullivan
authors: Biostatistics, University of Minnesota School of Public Health, Minneapolis, MN, USA.
authors: Andrew S
authors: AS
authors: Mugglin
authors: Minneapolis Heart Institute Foundation, Minneapolis, MN, USA.
authors: Linda M
authors: LM
authors: Retel
authors: Cardiology, Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA.
authors: Robert G
authors: RG
authors: Hauser
mesh_terms: D000367:Age Factors; D000368:Aged; D003404:Creatinine / Q000097:blood; D017147:Defibrillators, Implantable; D005260:Female; D006333:Heart Failure / Q000145:classification / Q000453:epidemiology; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008910:Minnesota / Q000453:epidemiology; D015999:Multivariate Analysis; D058729:Peripheral Arterial Disease / Q000401:mortality*; D018487:Ventricular Dysfunction, Left / Q000401:mortality* / Q000601:surgery
chemical_list: D003404:Creatinine
keywords: heart failure; implantable cardioverter defibrillator; peripheral artery disease; renal dysfunction