The IC-D score for predicting prophylactic cardioverter-defibrillator implantation following acute myocardial infarction
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Published on: August 9, 2024
Nicolas Clementy1, Reda Bensaid1, Jérémie Bouteau1
1Cardiology Department, Trousseau Hospital, University of Tours, Tours, France.
Insights
Predictors of poor left ventricular recovery after myocardial infarction (MI) include severely reduced ejection fraction and high cardiac enzyme levels. These factors indicate the need for cardioverter-defibrillator (ICD) implantation.
Area of Science:
- Cardiology
- Cardiovascular Medicine
- Biomarkers
Background:
- Reduced left ventricular ejection fraction (LVEF) after myocardial infarction (MI) may necessitate cardioverter-defibrillator (ICD) implantation.
- Identifying predictors of persistent LV dysfunction post-MI is crucial for patient management.
Purpose of the Study:
- To identify predictors of significant left ventricular (LV) remodeling post-MI.
- To develop a predictive score for persistent LVEF reduction.
Main Methods:
- Retrospective analysis of 150 MI patients with LVEF ≤35% at discharge.
- Logistic regression to identify predictors of non-recovery of LVEF at 6 weeks.
- External validation of a predictive score (IC-D score).
Main Results:
- An LVEF ≤25% at discharge and a peak CPK >4600 UI/L independently predicted non-recovery of LVEF.
- The IC-D score demonstrated good predictive performance (AUC 0.83 in the study population, 0.73 in validation cohort).
Conclusions:
- Severely reduced LVEF and elevated myocardial necrosis biomarkers predict unfavorable LV remodeling post-MI.
- These factors suggest the need for prophylactic ICD implantation.
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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