Comparison of Benefit and Mortality of Implantable Cardioverter-Defibrillator Therapy in Patients Aged ?5 Years Versus Those <75 Years

详细信息    查看全文

• 作者：Simon Brü ; llmann^a ; Wolfgang Dichtl ; MD^b ; Ursula Paoli^b ; Laurent Haegeli ; MD^a ; Christian Schmied ; MD^a ; Jan Steffel ; MD^a ; Corinna Brunckhorst ; MD^a ; Florian Hintringer ; MD^b ; Burkhard Seifert ; PhD^c ; Firat Duru ; MD^d ; Thomas Wolber ; MD^d ; ^{thomas.wolber@usz.ch}
• 刊名：The American Journal of Cardiology
• 出版年：2012
• 出版时间：1 March, 2012
• 年：2012
• 卷：109
• 期：5
• 页码：712-717
• 全文大小：716 K

文摘

Implantable cardioverter-defibrillator (ICD) therapy decreases arrhythmic and all-cause mortality in patients at high risk of sudden death. However, its clinical benefit in elderly patients is uncertain. The aim of this study was to assess the long-term efficacy of ICD treatment in elderly patients and to identify markers of successful ICD therapy and risk factors of mortality. We performed multivariate analysis of a prospective long-term database from 2 tertiary care centers including 936 consecutive patients with an ICD. Predictors of ICD therapy and risk factors for mortality were assessed in patients ?5 years old at ICD implantation compared to younger patients. Mean follow-up time was 43 ¡À40 months. Rates of ICD therapy were similar in the 2 age groups. No significant predictors of ICD therapy could be identified in older patients. Median estimated survival was 132 months in patients <75 years and 81 months in those ?5 years old (p = 0.006). Decreased ejection fraction (hazard ratio 1.62 per 10 % decrease, p = 0.03) and impaired renal function (hazard ratio 1.57 per 10 ml/kg/m² decrease in estimated glomerular filtration rate, p = 0.02) were independent risk factors of mortality in patients ?5 years old. However, mortality of older patients was similar to that of the age-matched general population irrespective of delivery of ICD therapy. In conclusion, ICD therapy is effective for treatment of life-threatening arrhythmias in all age groups. However, prevention of sudden cardiac death may have limited impact on overall mortality in older patients. Despite a similar rate of appropriate ICD therapies, risk of death is increased 1.6-fold in ICD recipients ?5 years old compared to younger patients. Patients with decreased ejection fraction and impaired renal function are at highest risk.