Article ; Online: The IC-D score for predicting prophylactic cardioverter-defibrillator implantation following acute myocardial infarction.
Pacing and clinical electrophysiology : PACE
2021 Volume 44, Issue 6, Page(s) 973–979
Abstract: Background: A reduced left ventricular ejection fraction (LVEF) ≤35% ≥6 weeks following an acute myocardial infarction (MI) may indicate prophylactic implantation of a cardioverter-defibrillator (ICD). We sought to find predictors of absence of ... ...
Abstract | Background: A reduced left ventricular ejection fraction (LVEF) ≤35% ≥6 weeks following an acute myocardial infarction (MI) may indicate prophylactic implantation of a cardioverter-defibrillator (ICD). We sought to find predictors of absence of significant left ventricular (LV) remodeling post-MI. Methods: All consecutive patients hospitalized for acute MI with an LVEF ≤35% at discharge in our institution from 2010 were retrospectively included. Patients were assigned to two groups according to the persistence of an LVEF ≤35% (ICD+) or a recovery >35% (ICD-). Logistic regression was performed to build a predictive score, which was then externally validated. Results: Among a total of 1533 consecutive MI patients, 150 met inclusion criteria, 53 (35%) in the ICD+ group and 97 in the ICD group. After multivariable analyses, an LVEF ≤25% at discharge (adjusted OR 6.23 [2.47 to 17.0], p < .0001) and a CPK peak at the MI acute phase >4600 UI/L (adjusted OR 9.99 [4.27 to 25.3], p < .0001) both independently predicted non-recovery at 6 weeks. The IC-D (Increased Cpk-LV Dysfunction) score predicted persistent LVEF ≤35% with areas under curve of 0.83 and 0.73, in the study population and in a multicenter validation cohort of 150 patients, respectively (p < .0001). Conclusions: The association of a severely reduced LVEF and a major release of myocardial necrosis biomarkers at the acute phase of MI predict unfavorable remodeling, and prophylactic ICD implantation. |
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MeSH term(s) | Aged ; Anticoagulants/therapeutic use ; Biomarkers/blood ; Defibrillators, Implantable ; Female ; Humans ; Male ; Middle Aged ; Predictive Value of Tests ; Retrospective Studies ; ST Elevation Myocardial Infarction/physiopathology ; ST Elevation Myocardial Infarction/prevention & control ; Stroke Volume |
Chemical Substances | Anticoagulants ; Biomarkers |
Language | English |
Publishing date | 2021-04-24 |
Publishing country | United States |
Document type | Journal Article |
ZDB-ID | 424437-0 |
ISSN | 1540-8159 ; 0147-8389 |
ISSN (online) | 1540-8159 |
ISSN | 0147-8389 |
DOI | 10.1111/pace.14244 |
Database | MEDical Literature Analysis and Retrieval System OnLINE |
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