Before undergoing ICD implantation, a practical risk score model has been shown to stratify patients into high- and low-risk groups for cardiac perforation or tamponade, according to a study published in the Journal of Cardiovascular Electrophysiology.

Using ACC’s ICD Registry, Santosh K. Padala, MD, FACC, et al., identified 438,679 patients who underwent de novo ICD implantation between 2010 and 2015. The researchers randomly split the patients into a derivation cohort (n=220,000) and a validation cohort (n=218,679). The predictors of intraprocedural cardiac injury were identified and then a risk score developed by the researchers, using the generalized estimating equations (GEEs) analysis with a quasi-likelihood under the independence model criterion goodness-of-fit statistics.

The risk of intraprocedural cardiac injury in the overall cohort was 0.13 percent. GEE analysis yielded seven variables that were strongly associated with intraprocedural cardiac injury (each assigned one point for the risk scoring): age >75 years, female gender, body mass index <18.5 kg/m², hypertension, chronic lung disease, left bundle branch block and continued warfarin use. Only prior history of coronary artery bypass grafting was associated with reduced risk ­­(–1 point).

Researchers found that the risk scoring system had good discrimination, with a C-statistic of 0.72. The risk of intraprocedural cardiac injury increased with an increase in risk score, from low risk (0.03 percent) to high risk (1.37 percent).

The investigators note that the incidence of intraprocedural cardiac injury is low in a real-world population of patients undergoing de novo ICD implantation, but is a potentially life-threatening complication. They conclude that a simple risk score model based on patient characteristics and comorbidities was able to stratify patients and help physicians and patients with planning ICD implantation.

Clinical Topics: Anticoagulation Management, Arrhythmias and Clinical EP, Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention, Prevention, Implantable Devices, EP Basic Science, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Cardiac Surgery and Arrhythmias, Hypertension

Keywords: ICD Registry, National Cardiovascular Data Registries, Incidence, Warfarin, Bundle-Branch Block, Research Personnel, Body Mass Index, Cohort Studies, Risk, Registries, Probability, Comorbidity, Coronary Artery Bypass, Lung Diseases, Electrophysiology, Hypertension

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