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The IC‐D score for predicting prophylactic cardioverter‐defibrillator implantation following acute myocardial infarction
Author(s) -
Clementy Nicolas,
Bensaid Reda,
Bouteau Jérémie,
Fedida Joël,
Kiavue Yoann,
Socie Pierre,
Ackermann Romain,
Goralski Marc,
Fauchier Laurent,
Bernard Anne,
Angoulvant Denis,
Babuty Dominique
Publication year - 2021
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/pace.14244
Subject(s) - medicine , ejection fraction , myocardial infarction , cardiology , implantable cardioverter defibrillator , logistic regression , ventricular remodeling , cohort , heart failure
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.