Clinical and serum-based markers are associated with death within 1 year of de novo implant in primary prevention ICD recipients

Yiyi Zhang, Eliseo Guallar, Elena Blasco-Colmenares, Darshan Dalal, Barbara Butcher, Sanaz Norgard, Fleur V.Y. Tjong, Zayd Eldadah, Timm Dickfeld, Kenneth A. Ellenbogen, Joseph E. Marine, Gordon F. Tomaselli, Alan Cheng

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Background Implantable cardioverter-defibrillator (ICD) implantation is contraindicated in those with <1-year life expectancy. Objectives The aim of this study was to develop a risk prediction score for 1-year mortality in patients with primary prevention ICDs and to determine the incremental improvement in discrimination when serum-based biomarkers are added to traditional clinical variables. Methods We analyzed data from the Prospective Observational Study of Implantable Cardioverter-Defibrillators, a large prospective observational study of patients undergoing primary prevention ICD implantation who were extensively phenotyped for clinical and serum-based biomarkers. We identified variables predicting 1-year mortality and synthesized them into a comprehensive risk scoring construct using backward selection. Results Of 1189 patients deemed by their treating physicians as having a reasonable 1-year life expectancy, 62 (5.2%) patients died within 1 year of ICD implantation. The risk score, composed of 6 clinical factors (age ≥75 years, New York Heart Association class III/IV, atrial fibrillation, estimated glomerular filtration rate <30 mL/min/1.73 m2, diabetes, and use of diuretics), had good discrimination (area under the curve 0.77) for 1-year mortality. Addition of 3 biomarkers (tumor necrosis factor α receptor II, pro-brain natriuretic peptide, and cardiac troponin T) further improved model discrimination to 0.82. Patients with 0-1, 2-3, 4-6, or 7-9 risk factors had 1-year mortality rates of 0.8%, 2.7%, 16.1%, and 46.2%, respectively. Conclusion Individuals with more comorbidities and elevation of specific serum biomarkers were at increased risk of all-cause mortality despite being deemed as having a reasonable 1-year life expectancy. A simple risk score composed of readily available clinical data and serum biomarkers may better identify patients at high risk of early mortality and improve patient selection and counseling for primary prevention ICD therapy.

Original languageEnglish (US)
Pages (from-to)360-366
Number of pages7
JournalHeart Rhythm
Volume12
Issue number2
DOIs
StatePublished - Feb 1 2015
Externally publishedYes

Fingerprint

Implantable Defibrillators
Primary Prevention
Biomarkers
Mortality
Life Expectancy
Serum
Observational Studies
Prospective Studies
Troponin T
Tumor Necrosis Factor Receptors
Brain Natriuretic Peptide
Age Factors
Glomerular Filtration Rate
Diuretics
Atrial Fibrillation
Patient Selection
Area Under Curve
Comorbidity
Counseling
Physicians

Keywords

  • Earlymortality
  • ICDshock
  • Implantablecardioverter-defibrillator
  • Primaryprevention
  • Sudden cardiacdeath

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Zhang, Y., Guallar, E., Blasco-Colmenares, E., Dalal, D., Butcher, B., Norgard, S., ... Cheng, A. (2015). Clinical and serum-based markers are associated with death within 1 year of de novo implant in primary prevention ICD recipients. Heart Rhythm, 12(2), 360-366. https://doi.org/10.1016/j.hrthm.2014.10.034

Clinical and serum-based markers are associated with death within 1 year of de novo implant in primary prevention ICD recipients. / Zhang, Yiyi; Guallar, Eliseo; Blasco-Colmenares, Elena; Dalal, Darshan; Butcher, Barbara; Norgard, Sanaz; Tjong, Fleur V.Y.; Eldadah, Zayd; Dickfeld, Timm; Ellenbogen, Kenneth A.; Marine, Joseph E.; Tomaselli, Gordon F.; Cheng, Alan.

In: Heart Rhythm, Vol. 12, No. 2, 01.02.2015, p. 360-366.

Research output: Contribution to journalArticle

Zhang, Y, Guallar, E, Blasco-Colmenares, E, Dalal, D, Butcher, B, Norgard, S, Tjong, FVY, Eldadah, Z, Dickfeld, T, Ellenbogen, KA, Marine, JE, Tomaselli, GF & Cheng, A 2015, 'Clinical and serum-based markers are associated with death within 1 year of de novo implant in primary prevention ICD recipients', Heart Rhythm, vol. 12, no. 2, pp. 360-366. https://doi.org/10.1016/j.hrthm.2014.10.034
Zhang, Yiyi ; Guallar, Eliseo ; Blasco-Colmenares, Elena ; Dalal, Darshan ; Butcher, Barbara ; Norgard, Sanaz ; Tjong, Fleur V.Y. ; Eldadah, Zayd ; Dickfeld, Timm ; Ellenbogen, Kenneth A. ; Marine, Joseph E. ; Tomaselli, Gordon F. ; Cheng, Alan. / Clinical and serum-based markers are associated with death within 1 year of de novo implant in primary prevention ICD recipients. In: Heart Rhythm. 2015 ; Vol. 12, No. 2. pp. 360-366.
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abstract = "Background Implantable cardioverter-defibrillator (ICD) implantation is contraindicated in those with <1-year life expectancy. Objectives The aim of this study was to develop a risk prediction score for 1-year mortality in patients with primary prevention ICDs and to determine the incremental improvement in discrimination when serum-based biomarkers are added to traditional clinical variables. Methods We analyzed data from the Prospective Observational Study of Implantable Cardioverter-Defibrillators, a large prospective observational study of patients undergoing primary prevention ICD implantation who were extensively phenotyped for clinical and serum-based biomarkers. We identified variables predicting 1-year mortality and synthesized them into a comprehensive risk scoring construct using backward selection. Results Of 1189 patients deemed by their treating physicians as having a reasonable 1-year life expectancy, 62 (5.2{\%}) patients died within 1 year of ICD implantation. The risk score, composed of 6 clinical factors (age ≥75 years, New York Heart Association class III/IV, atrial fibrillation, estimated glomerular filtration rate <30 mL/min/1.73 m2, diabetes, and use of diuretics), had good discrimination (area under the curve 0.77) for 1-year mortality. Addition of 3 biomarkers (tumor necrosis factor α receptor II, pro-brain natriuretic peptide, and cardiac troponin T) further improved model discrimination to 0.82. Patients with 0-1, 2-3, 4-6, or 7-9 risk factors had 1-year mortality rates of 0.8{\%}, 2.7{\%}, 16.1{\%}, and 46.2{\%}, respectively. Conclusion Individuals with more comorbidities and elevation of specific serum biomarkers were at increased risk of all-cause mortality despite being deemed as having a reasonable 1-year life expectancy. A simple risk score composed of readily available clinical data and serum biomarkers may better identify patients at high risk of early mortality and improve patient selection and counseling for primary prevention ICD therapy.",
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T1 - Clinical and serum-based markers are associated with death within 1 year of de novo implant in primary prevention ICD recipients

AU - Zhang, Yiyi

AU - Guallar, Eliseo

AU - Blasco-Colmenares, Elena

AU - Dalal, Darshan

AU - Butcher, Barbara

AU - Norgard, Sanaz

AU - Tjong, Fleur V.Y.

AU - Eldadah, Zayd

AU - Dickfeld, Timm

AU - Ellenbogen, Kenneth A.

AU - Marine, Joseph E.

AU - Tomaselli, Gordon F.

AU - Cheng, Alan

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N2 - Background Implantable cardioverter-defibrillator (ICD) implantation is contraindicated in those with <1-year life expectancy. Objectives The aim of this study was to develop a risk prediction score for 1-year mortality in patients with primary prevention ICDs and to determine the incremental improvement in discrimination when serum-based biomarkers are added to traditional clinical variables. Methods We analyzed data from the Prospective Observational Study of Implantable Cardioverter-Defibrillators, a large prospective observational study of patients undergoing primary prevention ICD implantation who were extensively phenotyped for clinical and serum-based biomarkers. We identified variables predicting 1-year mortality and synthesized them into a comprehensive risk scoring construct using backward selection. Results Of 1189 patients deemed by their treating physicians as having a reasonable 1-year life expectancy, 62 (5.2%) patients died within 1 year of ICD implantation. The risk score, composed of 6 clinical factors (age ≥75 years, New York Heart Association class III/IV, atrial fibrillation, estimated glomerular filtration rate <30 mL/min/1.73 m2, diabetes, and use of diuretics), had good discrimination (area under the curve 0.77) for 1-year mortality. Addition of 3 biomarkers (tumor necrosis factor α receptor II, pro-brain natriuretic peptide, and cardiac troponin T) further improved model discrimination to 0.82. Patients with 0-1, 2-3, 4-6, or 7-9 risk factors had 1-year mortality rates of 0.8%, 2.7%, 16.1%, and 46.2%, respectively. Conclusion Individuals with more comorbidities and elevation of specific serum biomarkers were at increased risk of all-cause mortality despite being deemed as having a reasonable 1-year life expectancy. A simple risk score composed of readily available clinical data and serum biomarkers may better identify patients at high risk of early mortality and improve patient selection and counseling for primary prevention ICD therapy.

AB - Background Implantable cardioverter-defibrillator (ICD) implantation is contraindicated in those with <1-year life expectancy. Objectives The aim of this study was to develop a risk prediction score for 1-year mortality in patients with primary prevention ICDs and to determine the incremental improvement in discrimination when serum-based biomarkers are added to traditional clinical variables. Methods We analyzed data from the Prospective Observational Study of Implantable Cardioverter-Defibrillators, a large prospective observational study of patients undergoing primary prevention ICD implantation who were extensively phenotyped for clinical and serum-based biomarkers. We identified variables predicting 1-year mortality and synthesized them into a comprehensive risk scoring construct using backward selection. Results Of 1189 patients deemed by their treating physicians as having a reasonable 1-year life expectancy, 62 (5.2%) patients died within 1 year of ICD implantation. The risk score, composed of 6 clinical factors (age ≥75 years, New York Heart Association class III/IV, atrial fibrillation, estimated glomerular filtration rate <30 mL/min/1.73 m2, diabetes, and use of diuretics), had good discrimination (area under the curve 0.77) for 1-year mortality. Addition of 3 biomarkers (tumor necrosis factor α receptor II, pro-brain natriuretic peptide, and cardiac troponin T) further improved model discrimination to 0.82. Patients with 0-1, 2-3, 4-6, or 7-9 risk factors had 1-year mortality rates of 0.8%, 2.7%, 16.1%, and 46.2%, respectively. Conclusion Individuals with more comorbidities and elevation of specific serum biomarkers were at increased risk of all-cause mortality despite being deemed as having a reasonable 1-year life expectancy. A simple risk score composed of readily available clinical data and serum biomarkers may better identify patients at high risk of early mortality and improve patient selection and counseling for primary prevention ICD therapy.

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KW - ICDshock

KW - Implantablecardioverter-defibrillator

KW - Primaryprevention

KW - Sudden cardiacdeath

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