title: Outcome of Primary Prevention Implantable Cardioverter Defibrillator Therapy According to New York Heart Association Functional Classification.
abstract: We aimed to assess if the outcome of primary prevention implantable cardioverter defibrillators (ICDs) without cardiac resynchronization therapy is dependent on New York Heart Association (NYHA) class. Among the participants of Défibrillateur Automatique Implantable-Prévention Primaire (DAI-PP; NCT01992458) multicenter cohort study, 155 patients in NYHA class I, 504 in NYHA class II, and 188 in NYHA class III had a QRS width <120 ms and were implanted with an ICD without cardiac resynchronization therapy and, thus, were eligible for the purpose of this analysis. Total and specific mortalities and the incidence of appropriate therapies were assessed for every NYHA. During 2,606 patient-years (3.1 ± 2.1 years), 104 (12.3%) subjects died and 188 (22.2%) experienced appropriate therapies. After adjustment, overall mortality increased with NYHA class (adjusted hazard ratio [HR] 1.63, 95% confidence interval [CI] 1.11 to 2.41, p = 0.014), driven by an increase in cardiovascular death. Conversely, incidence of appropriate ICD intervention was comparable among the 3 NYHA groups (NYHA class I 7.43, NYHA class II 7.91, and NYHA class III 12.10 per 100 patient-years; HR 1.19, 95% CI 0.89 to 1.59, p = 0.231). Incidence of ICD-unresponsive sudden death was very low and also comparable (NYHA class I 0.22, NYHA class II 0.36, and NYHA class III 0.83 per 100 patient-years (HR 6.34, 95% CI 0.32 to 124.49, p = 0.224). No significant differences were observed in the other specific modes of death. In conclusion, although patients in NYHA class III have higher overall mortality, they experience a comparable incidence of appropriate ICD therapies. The low incidence of ICD-unresponsive sudden death in all assessed NYHA classes also supports the efficacy of ICDs, irrespective of NYHA class.
authors: Clinique Pasteur, Toulouse, France; Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom.
authors: Rui
authors: R
authors: Providência
authors: Clinique Pasteur, Toulouse, France. Electronic address: sboveda@clinique-pasteur.com.
authors: Serge
authors: S
authors: Boveda
authors: CHU Michallon, Grenoble, France.
authors: Pascal
authors: P
authors: Defaye
authors: Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom.
authors: Oliver
authors: O
authors: Segal
authors: CHU Antoine Béclère, Clamart, France.
authors: Vincent
authors: V
authors: Algalarrondo
authors: CHU Brabois, Nancy, France.
authors: Nicolas
authors: N
authors: Sadoul
authors: Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom; Institute of Cardiovascular Sciences, University College of London, London, United Kingdom.
authors: Pier
authors: P
authors: Lambiase
authors: Centre Cardiologique du Nord, Saint Denis, France.
authors: Olivier
authors: O
authors: Piot
authors: CHRU Lille, Lille, France.
authors: Didier
authors: D
authors: Klug
authors: Hôpital Européen Georges Pompidou, Paris, France.
authors: Marie-Cecile
authors: MC
authors: Perier
authors: Clinique Pasteur, Toulouse, France.
authors: Abdeslam
authors: A
authors: Bouzeman
authors: Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom.
authors: Sergio
authors: S
authors: Barra
authors: Hôpital Européen Georges Pompidou, Paris, France.
authors: Marie-Cécile
authors: MC
authors: Bories
authors: Nouvelles Cliniques Nantaises, Nantes, France.
authors: Daniel
authors: D
authors: Gras
authors: CHU Trousseau, Tours, France.
authors: Laurent
authors: L
authors: Fauchier
authors: CHU Haut Lévêque, Bordeaux, France.
authors: Pierre
authors: P
authors: Bordachar
authors: CHU Trousseau, Tours, France.
authors: Dominique
authors: D
authors: Babuty
authors: CHU La Timone, Marseille, France.
authors: Jean-Claude
authors: JC
authors: Deharo
authors: Cardiology Department, CHU Pontchaillou, Rennes, France.
authors: Christophe
authors: C
authors: Leclercq
authors: Hôpital Européen Georges Pompidou, Paris, France.
authors: Eloi
authors: E
authors: Marijon
mesh_terms: D000368:Aged; D002423:Cause of Death; D015331:Cohort Studies; D016757:Death, Sudden, Cardiac / Q000209:etiology / Q000517:prevention & control*; D017147:Defibrillators, Implantable; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality; D015999:Multivariate Analysis; D011322:Primary Prevention; D016016:Proportional Hazards Models; D012720:Severity of Illness Index