title: Applicability of a risk score for prediction of the long-term benefit of the implantable cardioverter defibrillator in patients receiving cardiac resynchronization therapy.
abstract: OBJECTIVE
  The Goldenberg risk score, comprising five clinical risk factors (New York Heart Association class >2, atrial fibrillation, QRS duration >120 ms, age >70 years, and urea >26 mg/dL), may help identify patients in whom the survival benefit of the defibrillator may be limited. We aim at assessing whether this score can accurately predict the long-term all-cause mortality risk of patients receiving cardiac resynchronization therapy (CRT) and identify those who are more likely to benefit from the defibrillator.
  
  
  RESULTS
  In this retrospective observational cohort study, 638 patients with ischaemic or non-ischaemic dilated cardiomyopathy who had CRT-defibrillator (CRT-D) (n = 224) vs. CRT-pacemaker (CRT-P) (n = 414) implantation were prospectively followed up for survival outcomes. The long-term outcome of patients with CRT-D vs. CRT-P was compared within risk score categories and in patients with severe renal dysfunction. Mean follow-up in surviving and deceased patients was 62.7 and 32.5 months, respectively. This score showed higher discriminative performance in all-cause mortality prediction in CRT-D vs. CRT-P patients (area under the curve 0.718 ± 0.041 vs. 0.650 ± 0.032, respectively, P = 0.001). In those with scores 0-2, a CRT-D device decreased mortality rates in the first 4 years of follow-up compared with CRT-P (11.3 vs. 24.7%, P = 0.041), but this effect attenuated with longer follow-up duration (21.2 vs. 32.7%, P = 0.078). In this group, the benefit of CRT-D during the follow-up was seen after adjusting for traditional mortality predictors (hazard ratio 0.339, P = 0.001). No significant differences in mortality rates were seen in patients with score ≥3 (57.9% with CRT-D vs. 56.9%, P = 0.8) and those with severe renal dysfunction (92.9% in CRT-D vs. 76.2%, P = 0.17). Similar results were seen following propensity score matching.
  
  
  CONCLUSIONS
  A simple risk stratification score comprising five clinical risk factors may help identify CRT patients who are more likely to benefit from the presence of the defibrillator.
authors.affiliation: Cardiology Department, Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridge CB23 3RE, UK sergioncbarra@gmail.com.
authors.forename: Sérgio
authors.initials: S
authors.lastname: Barra
authors.affiliation: Green Lane Cardiovascular Services, Level 3, Auckland City Hospital, Grafton, Auckland 1023, New Zealand.
authors.forename: Khang-Li
authors.initials: KL
authors.lastname: Looi
authors.affiliation: Cardiology Department, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich NR4 7UY, UK.
authors.forename: Parag R
authors.initials: PR
authors.lastname: Gajendragadkar
authors.affiliation: Cardiology Department, University College London Hospitals NHS Foundation Trust, London, UK.
authors.forename: Fakhar Z
authors.initials: FZ
authors.lastname: Khan
authors.affiliation: Cardiology Department, Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridge CB23 3RE, UK.
authors.forename: Munmohan
authors.initials: M
authors.lastname: Virdee
authors.affiliation: Cardiology Department, Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridge CB23 3RE, UK.
authors.forename: Sharad
authors.initials: S
authors.lastname: Agarwal
mesh_terms: D000368:Aged; D058406:Cardiac Resynchronization Therapy / Q000379:methods*; D058409:Cardiac Resynchronization Therapy Devices; D017147:Defibrillators, Implantable; D004554:Electric Countershock / Q000295:instrumentation*; D005260:Female; D006333:Heart Failure / Q000401:mortality / Q000628:therapy*; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D062606:Tertiary Care Centers; D013997:Time Factors; D016896:Treatment Outcome; D006113:United Kingdom; D016277:Ventricular Function, Left
keywords: All-cause mortality; Cardiac resynchronization therapy; Implantable cardioverter defibrillator; Risk score; Risk stratification