Implanted cardioverter defibrillator therapy has been shown to be associated with
a significant reduction in the risk of sudden cardiac death (SCD) in patients with
ischemic left ventricular dysfunction. However, data on the relation between renal
function and SCD in this population are limited, and the effect of renal dysfunction
on the implanted cardioverter defibrillator benefit has not been determined. We performed
a retrospective analysis of the outcome associated with renal dysfunction, as determined
by the estimated glomerular filtration rate (eGFR), in patients enrolled in the Multicenter
Automatic Defibrillator Implantation Trial-II. Multivariate analysis in conventionally
treated patients showed that for each 10-U reduction in eGFR, the risk of all-cause
mortality and SCD increased by 16% (p = 0.005) and 17% (p = 0.03), respectively. Defibrillator
therapy was associated with a survival benefit in each eGFR category of ≥35 ml/min/1.73
m2 (overall risk reduction for all-cause mortality 32%, p = 0.01 and for SCD 66%, p
<0.001). However, no implanted cardioverter defibrillator benefit was shown among
patients with an eGFR <35 ml/min/1.73 m2 (all-cause mortality hazard ratio 1.09, p = 0.84; SCD hazard ratio 0.95, p = 0.95).
In conclusion, in patients with high-risk cardiac disease enrolled in the Multicenter
Automatic Defibrillator Implantation Trial-II, a significant increase was found in
the risk of SCD with declining renal function. Defibrillator therapy was associated
with a significant survival benefit among the study patients with mild to moderate
or no renal disease, but no benefit was shown among patients with more advanced renal
dysfunction.
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Article info
Publication history
Published online: June 22, 2006
Accepted:
March 2,
2006
Received in revised form:
February 2,
2006
Received:
October 13,
2005
Identification
Copyright
© 2006 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
