A propensity matched case-control study comparing efficacy, safety and costs of the subcutaneous vs. transvenous implantable cardioverter defibrillator

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• 作者：S. Honarbakhsh ; R. Providencia ; N. Srinivasan ; S. Ahsan ; M. Lowe ; E. Rowland ; RJ Hunter ; M. Finlay ; O. Segal ; MJ Earley ; A. Chow ; RJ Schilling ; PD Lambiase ; ^{p.lambiase@ucl.ac.uk}
• 关键词：Sudden cardiac death ; Implantable cardioverter defibrillator ; Lead ; Device-related complications
• 刊名：International Journal of Cardiology
• 出版年：2017
• 出版时间：1 February 2017
• 年：2017
• 卷：228
• 期：Complete
• 页码：280-285
• 全文大小：404 K
• 卷排序：228

文摘

Subcutaneous implantable cardioverter defibrillators (S-ICD) have become more widely available. However, comparisons with conventional transvenous ICDs (TV-ICD) are scarce.MethodsWe conducted a propensity matched case–control study including all patients that underwent S-ICD implantation over a five-year period in a single tertiary centre. Controls consisted of all TV-ICD implant patients over a contemporary time period excluding those with pacing indication, biventricular pacemakers and those with sustained monomorphic ventricular tachycardia requiring anti-tachycardia pacing. Data was collected on device-related complications and mortality rates. A cost efficacy analysis was performed.ResultsSixty-nine S-ICD cases were propensity matched to 69 TV-ICD controls. During a mean follow-up of 31 ± 19 (S-ICD) and 32 ± 21 months (TV-ICD; p = 0.88) there was a higher rate of device-related complications in the TV-ICD group predominantly accounted for by lead failures (n = 20, 29% vs. n = 6, 9%; p = 0.004). The total mean cost for each group, including the complication-related costs was £9967 ± 4511 ($13,639 ± 6173) and £12,601 ± 1786 ($17,243 ± 2444) in the TV-ICD and S-ICD groups respectively (p = 0.0001). Even though more expensive S-ICD was associated with a relative risk reduction of device-related complication of 70% with a HR of 0.30 (95%CI 0.12–0.76; p = 0.01) compared to TV-ICDs.ConclusionsTV-ICDs are associated with increased device-related complication rates compared to a propensity matched S-ICD group during a similar follow-up period. Despite the existing significant difference in unit cost of the S-ICD, overall S-ICD costs may be mitigated versus TV-ICDs over a longer follow-up period.