Appropriate Shocks and Mortality in Patients With Versus Without Diabetes With Prophylactic Implantable Cardioverter Defibrillators
Authors: M. Juhani Junttila, Ari Pelli, Tuomas V. Kenttä, Tim Friede, Rik Willems, Leonard Bergau, Marek Malik, Bert Vandenberk, Marc A. Vos, Georg Schmidt, Bela Merkely, Andrzej Lubinski, Martin Svetlosak, Frieder Braunschweig, Markus Harden, Markus Zabel, Heikki V. Huikuri, Christian Sticherling, Markus Zabel, Joachim Seegers, Leonard Bergau, Gerd Hasenfuß, Pascal Munoz-Exposito, Tobias Tichelbäcker, Aleksandra Kirova, Simon Schlögl, Rajevaa Sritharan, Katharina Jörß, Jessica Macken, Misbah Misdaq, Kornelia Rudolph, Markus Zabel, Gerd Hasenfuß, Tim Friede, Axel Bauer, Christine Meyer-Zürn, Christian Eick, Klinikum rechts der Isar, Goerg Schmidt, Alexander Müller, Michael Dommasch, Daniel Sinnecker, Stefan Kääb, Moritz F. Sinner, Axel Bauer, Rüdiger Dissmann, Ute Burmester, Steffen Behrens, Martina Gregor, Stefan Stefanow, Norman Rüb, Christian Wolpert, Dieter Bimmel, Christiane Lieberz, Joachim Seegers, Lars S. Maier, Robert H.G. Schwinger, Florian Blaschke, Burkert Pieske, Gerian Grönefeld, Gunnar Klein, Ajmal Gardiwal, Bela Merkely, Gabor Szeplaki, Peter Perge, Janko Szavits Nossan, Luka Rotkvić, Nikola Pavlovic, Sime Manola, Ozren Vinter, Ivica Benko, Sandro Brusic, Ervin Avdovic, Marina Klasan, Zoran Bakotic, Ante Anic, Zrinka Jurisic, Andrzej Lubinski, Emilia Kowalczyk, Tomasz Kucejko, Agnieszka Czechowska, Katarina Wybor, Iwona Cygankiewicz, Pawel Ptaszyński, Jaroslaw Kasprzak, Dariusz Qavoq, Przemyslaw Guzik, Tomasz Krauze, Maciej Sterlinski, Robert Hatala, Martin Svetlosak, Gabriela Kaliska, Jozef Martinek, Jesper Hastrup Svendsen, Karen Thamsborg, Jim Hansen, Ida-Maria Schloett-Hyldelund, Julie Laage-Petersen, Rik Willems, Bert Vandenberk, Sofie van Soest, Panayota Flevari, Dimitrios Katsaras, Andreas Katsimardos, Dionyssios Leftheriotis, Konstantinia Papangelopoulou, Charalambos Varlamos, Vassil Traykov, Vasil Velchev, Svetoslav Iovev, Tchavdar Shalganov, Christian Sticherling, David Conen, Sarah Giesebart, Tomas Novotny, Milan Kozak, Milos Taborsky, Jan Galuszka, Anton E. Tuinenburg, Sofieke Wijers, Marc A. Vos, Sofieke Wijers, Albert Dunnink, David Sprenkeler, Josep Brugada, Elena Arbelo, Emilce Trucco, Silvia Vidorreta, Heikki V. Huikuri, Tuomas Kenttä, Ari Pelli, Pirkko Huikuri, Päivi Koski, Frieder Braunschweig, Helena Karlsson, David Ersgaard, Pyotr Platonov, Gerian Grönefeld, Thomas Klingenheben
Journal: Diabetes Care (2019)

OBJECTIVE Diabetes increases the risk of all-cause mortality and sudden cardiac death (SCD). The exact mechanisms leading to sudden death in diabetes are not well known. We compared the incidence of appropriate shocks and mortality in patients with versus without diabetes with a prophylactic implantable cardioverter defibrillator (ICD) included in the retrospective EU-CERT-ICD registry. RESEARCH DESIGN AND METHODS AND RESULTS A total of 3,535 patients from 12 European EU-CERT-ICD centers with a mean age of 63.7 ± 11.2 years (82% males) at the time of ICD implantation were included in the analysis. A total of 995 patients (28%) had a history of diabetes. All patients had an ICD implanted for primary SCD prevention. End points were appropriate shock and all-cause mortality. Mean follow-up time was 3.2 ± 2.3 years. Diabetes was associated with a lower risk of appropriate shocks (adjusted hazard ratio [HR] 0.77 [95% CI 0.62–0.96], P = 0.02). However, patients with diabetes had significantly higher mortality (adjusted HR 1.30 [95% CI 1.11–1.53], P = 0.001). CONCLUSIONS All-cause mortality is higher in patients with diabetes than in patients without diabetes with primary prophylactic ICDs. Subsequently, patients with diabetes have a lower incidence of appropriate ICD shocks, indicating that the excess mortality might not be caused primarily by ventricular tachyarrhythmias. These findings suggest a limitation of the potential of prophylactic ICD therapy to improve survival in patients with diabetes with impaired left ventricular function.