Elsevier

American Heart Journal

Volume 246, April 2022, Pages 21-31
American Heart Journal

Clinical Investigations
Risk and predictors of mortality after implantable cardioverter-defibrillator implantation in patients with sarcoid cardiomyopathy

https://doi.org/10.1016/j.ahj.2021.12.011Get rights and content

Background

Implantable cardioverter-defibrillators (ICDs) are recommended for patients with cardiac sarcoidosis (CS) with an indication for pacing, prior ventricular arrhythmias, cardiac arrest, or left ventricular ejection fraction <35%, but data on outcomes are limited.

Methods

Using data from the National Cardiovascular Data Registry ICD Registry between April 1, 2010 and December 31, 2015, we evaluated a propensity matched cohort of CS patients implanted with ICDs versus non-ischemic cardiomyopathies (NICM). We compared mortality using Kaplan-Meier survival curves and Cox proportional hazards models.

Results

We identified 1,638 patients with CS and 8,190 propensity matched patients with NICM. The rate of death at 1 and 2 years was similar in patients with CS and patients with NICM (5.2% vs 5.4%, P = 0.75 and 9.0% vs 9.3%, P = 0.72, respectively). After adjusting for other covariates, patients with CS had similar mortality at 2 years after ICD implantations compared with NICM patients (RR 1.03, 95% CI 0.87-1.23). Among patients with CS, multivariable logistic regression identified 6 factors significantly associated with increased 2-year mortality: presence of heart failure (HR 1.92, 95% CI 1.44-3.22), New York Heart Association (NYHA) Class III heart failure (HR 1.68, 95% CI 1.16-2.45), NYHA Class IV heart failure (HR 3.08, 95% CI 1.49-6.39), atrial fibrillation/flutter (HR 1.66, 95% CI 1.17-2.35), chronic lung disease (HR 1.64, 95% CI 1.17-2.29), creatinine >2.0 mg/dL (HR 4.07, 95% CI 2.63-6.30), and paced rhythm (HR 2.66, 95% CI 1.07-6.59).

Conclusion

Mortality following ICD implantation was similar in CS patients compared with propensity matched NICM patients. Presence of heart failure, NYHA class, atrial fibrillation/flutter, chronic lung disease, renal dysfunction, and paced rhythm at time of implantation were all predictors of increased 2-year mortality among CS patients with ICDs.

Section snippets

Background

Cardiac sarcoidosis (CS) is a type of non-ischemic cardiomyopathy (NICM) characterized by patchy granulomatous infiltration of the myocardium. Approximately 5% of sarcoidosis patients demonstrate overt cardiac involvement and up to 25% have clinically silent cardiac involvement based on pathological or imaging findings.1,2 The overall prognosis of patients with CS has previously been shown to be favorable with a 97% transplant-free survival at 1-year which decreases to 90% at 5 years and 83% at

Data sources

The NCDR ICD Registry was established in 2005 by the American College of Cardiology and the Heart Rhythm Society as a centralized data registry for patients undergoing ICD implantations. The registry met the Centers for Medicare and Medicaid Services (CMS) data collection requirements and in early 2006 CMS mandated that all Medicare patients receiving primary prevention ICDs be included in the registry; however, 90% of participating hospitals reported on other patient populations such as those

Baseline patient population and propensity matched cohort

There were 917,615 patients in the ICD Registry between April 1, 2010 and December 31, 2015. After excluding patients with a prior ICD (n = 398,055) or pacemaker (n = 54,776), patients with an epicardial system (n = 11,596), and patients with cardiac amyloidosis (n = 593), 452,595 patients comprised the study sample (Figure 1). Of these patients, 2,162 had CS and 450,433 had NICM. The baseline characteristics of the entire cohort prior to propensity matching are shown in Supplemental Table I.

Discussion

In this study of 1,638 patients with CS implanted with ICDs, mortality rates at 2 years were similar to propensity matched NICM patients. Among patients with CS, risk factors for 2-year mortality included presence of heart failure and severity of heart failure (NYHA class III or IV), atrial arrhythmias, chronic lung disease, renal dysfunction (creatinine >2 mg/dL), and paced rhythm. This information may help inform clinicians and patients regarding mortality risk in those with CS considering

Author contributions

Angela Y. Higgins: Conceptualization, methodology, writing-original draft, review and editing, visualization. Amarnath R. Annapureddy: Conceptualization, methodology, writing- review and editing. Yongfei Wang: Methodology, formal analysis, data curation, writing- review and editing. Karl E. Minges: Methodology, writing- review and editing, project administration. Lavanya Bellumkonda: Writing- review and editing. Rachel Lampert: Writing- review and editing. Lynda E. Rosenfeld: Writing- review

Funding

This research was supported by the American College of Cardiology (ACC) Foundation's National Cardiovascular Data Registry (NCDR). The views expressed represent those of the author(s) and do not necessarily represent the official views of the NCDR or its associated professional societies (www.ncdr.com).

Data statement

Data are available upon reasonable request.

Declaration of interest

Dr Minges and Yongfei Wang receive salary support for analytic services provided to the American College of Cardiology. Dr Lampert reports research grants from Medtronic and Abbott Laboratories/St. Jude Medical and serves on Medtronic advisory board and receives moderate honoraria. Dr Rosenfeld reports fellowship support and stock ownership for Abbott Laboratories and fellowship support from Boston Scientific and Medtronic. Dr Jacoby reports being on the speaker's bureau and an advisory board

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