Troponin levels after ICD implantation with and without defibrillation testing and their predictive value for outcomes: Insights from the SIMPLE trial

Mate Vamos, Jeff S. Healey, Jia Wang, G. Duray, Stuart J. Connolly, Lieselot Van Erven, Xavier Vinolas, Jorg Neuzner, Michael Glikson, Stefan H. Hohnloser

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Background The Shockless IMPLant Evaluation trial randomized 2500 patients receiving a first implantable cardioverter-defibrillator (ICD)/cardiac resynchronization therapy-defibrillator device to have either defibrillation testing (DT) or no DT. It demonstrated that DT did not improve shock efficacy or reduce mortality. Objective This prospective substudy evaluated the effect of DT on postoperative troponin levels and their predictive value for total and arrhythmic mortality. Methods Troponin levels were measured between 6 and 24 hours after ICD implantation in 2200 of 2500 patients. Results A postoperative serum troponin level above the upper limit of normal (ULN) was more common in patients undergoing DT (n = 509 [46.4%]) than in those not subjected to DT (n = 456 [41.3%]; P =.02). After excluding patients with known preoperative troponin levels above the ULN, consistent findings were observed (42.1% vs 37.5%; P =.04). During a mean follow-up of 3.1 ± 1.0 years, the annual mortality rate was increased in patients with postoperative troponin levels above the ULN (adjusted hazard ratio [HR] 1.43; 95% confidence interval [CI] 1.15-1.76; P =.001) irrespective of DT or no DT. Likewise, patients with elevated troponin levels had a significantly higher risk of arrhythmic death (adjusted HR 1.80; 95% CI 1.23-2.63; P =.002). The rate of first appropriate ICD shock (adjusted HR 0.89; 95% CI 0.71-1.12; P =.32) or failed appropriate shock (adjusted HR 1.02; 95% CI 0.59-1.76; P =.95) was similar in patients with or without troponin elevation. Conclusion DT at the time of ICD implantation is associated with increased troponin levels, indicating subclinical myocardial injury caused by the procedure. Elevated troponin levels but not DT seem to predict clinical outcomes in ICD recipients.

Original languageEnglish
Pages (from-to)504-510
Number of pages7
JournalHeart Rhythm
Volume13
Issue number2
DOIs
Publication statusPublished - Feb 1 2016

Fingerprint

Troponin
Implantable Defibrillators
Confidence Intervals
Shock
Mortality
Cardiac Resynchronization Therapy Devices
Defibrillators
Wounds and Injuries

Keywords

  • Defibrillation testing
  • Implantable cardioverter-defibrillator
  • Mortality
  • Troponin I
  • Troponin T

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Troponin levels after ICD implantation with and without defibrillation testing and their predictive value for outcomes : Insights from the SIMPLE trial. / Vamos, Mate; Healey, Jeff S.; Wang, Jia; Duray, G.; Connolly, Stuart J.; Van Erven, Lieselot; Vinolas, Xavier; Neuzner, Jorg; Glikson, Michael; Hohnloser, Stefan H.

In: Heart Rhythm, Vol. 13, No. 2, 01.02.2016, p. 504-510.

Research output: Contribution to journalArticle

Vamos, M, Healey, JS, Wang, J, Duray, G, Connolly, SJ, Van Erven, L, Vinolas, X, Neuzner, J, Glikson, M & Hohnloser, SH 2016, 'Troponin levels after ICD implantation with and without defibrillation testing and their predictive value for outcomes: Insights from the SIMPLE trial', Heart Rhythm, vol. 13, no. 2, pp. 504-510. https://doi.org/10.1016/j.hrthm.2015.11.009
Vamos, Mate ; Healey, Jeff S. ; Wang, Jia ; Duray, G. ; Connolly, Stuart J. ; Van Erven, Lieselot ; Vinolas, Xavier ; Neuzner, Jorg ; Glikson, Michael ; Hohnloser, Stefan H. / Troponin levels after ICD implantation with and without defibrillation testing and their predictive value for outcomes : Insights from the SIMPLE trial. In: Heart Rhythm. 2016 ; Vol. 13, No. 2. pp. 504-510.
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abstract = "Background The Shockless IMPLant Evaluation trial randomized 2500 patients receiving a first implantable cardioverter-defibrillator (ICD)/cardiac resynchronization therapy-defibrillator device to have either defibrillation testing (DT) or no DT. It demonstrated that DT did not improve shock efficacy or reduce mortality. Objective This prospective substudy evaluated the effect of DT on postoperative troponin levels and their predictive value for total and arrhythmic mortality. Methods Troponin levels were measured between 6 and 24 hours after ICD implantation in 2200 of 2500 patients. Results A postoperative serum troponin level above the upper limit of normal (ULN) was more common in patients undergoing DT (n = 509 [46.4{\%}]) than in those not subjected to DT (n = 456 [41.3{\%}]; P =.02). After excluding patients with known preoperative troponin levels above the ULN, consistent findings were observed (42.1{\%} vs 37.5{\%}; P =.04). During a mean follow-up of 3.1 ± 1.0 years, the annual mortality rate was increased in patients with postoperative troponin levels above the ULN (adjusted hazard ratio [HR] 1.43; 95{\%} confidence interval [CI] 1.15-1.76; P =.001) irrespective of DT or no DT. Likewise, patients with elevated troponin levels had a significantly higher risk of arrhythmic death (adjusted HR 1.80; 95{\%} CI 1.23-2.63; P =.002). The rate of first appropriate ICD shock (adjusted HR 0.89; 95{\%} CI 0.71-1.12; P =.32) or failed appropriate shock (adjusted HR 1.02; 95{\%} CI 0.59-1.76; P =.95) was similar in patients with or without troponin elevation. Conclusion DT at the time of ICD implantation is associated with increased troponin levels, indicating subclinical myocardial injury caused by the procedure. Elevated troponin levels but not DT seem to predict clinical outcomes in ICD recipients.",
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T1 - Troponin levels after ICD implantation with and without defibrillation testing and their predictive value for outcomes

T2 - Insights from the SIMPLE trial

AU - Vamos, Mate

AU - Healey, Jeff S.

AU - Wang, Jia

AU - Duray, G.

AU - Connolly, Stuart J.

AU - Van Erven, Lieselot

AU - Vinolas, Xavier

AU - Neuzner, Jorg

AU - Glikson, Michael

AU - Hohnloser, Stefan H.

PY - 2016/2/1

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N2 - Background The Shockless IMPLant Evaluation trial randomized 2500 patients receiving a first implantable cardioverter-defibrillator (ICD)/cardiac resynchronization therapy-defibrillator device to have either defibrillation testing (DT) or no DT. It demonstrated that DT did not improve shock efficacy or reduce mortality. Objective This prospective substudy evaluated the effect of DT on postoperative troponin levels and their predictive value for total and arrhythmic mortality. Methods Troponin levels were measured between 6 and 24 hours after ICD implantation in 2200 of 2500 patients. Results A postoperative serum troponin level above the upper limit of normal (ULN) was more common in patients undergoing DT (n = 509 [46.4%]) than in those not subjected to DT (n = 456 [41.3%]; P =.02). After excluding patients with known preoperative troponin levels above the ULN, consistent findings were observed (42.1% vs 37.5%; P =.04). During a mean follow-up of 3.1 ± 1.0 years, the annual mortality rate was increased in patients with postoperative troponin levels above the ULN (adjusted hazard ratio [HR] 1.43; 95% confidence interval [CI] 1.15-1.76; P =.001) irrespective of DT or no DT. Likewise, patients with elevated troponin levels had a significantly higher risk of arrhythmic death (adjusted HR 1.80; 95% CI 1.23-2.63; P =.002). The rate of first appropriate ICD shock (adjusted HR 0.89; 95% CI 0.71-1.12; P =.32) or failed appropriate shock (adjusted HR 1.02; 95% CI 0.59-1.76; P =.95) was similar in patients with or without troponin elevation. Conclusion DT at the time of ICD implantation is associated with increased troponin levels, indicating subclinical myocardial injury caused by the procedure. Elevated troponin levels but not DT seem to predict clinical outcomes in ICD recipients.

AB - Background The Shockless IMPLant Evaluation trial randomized 2500 patients receiving a first implantable cardioverter-defibrillator (ICD)/cardiac resynchronization therapy-defibrillator device to have either defibrillation testing (DT) or no DT. It demonstrated that DT did not improve shock efficacy or reduce mortality. Objective This prospective substudy evaluated the effect of DT on postoperative troponin levels and their predictive value for total and arrhythmic mortality. Methods Troponin levels were measured between 6 and 24 hours after ICD implantation in 2200 of 2500 patients. Results A postoperative serum troponin level above the upper limit of normal (ULN) was more common in patients undergoing DT (n = 509 [46.4%]) than in those not subjected to DT (n = 456 [41.3%]; P =.02). After excluding patients with known preoperative troponin levels above the ULN, consistent findings were observed (42.1% vs 37.5%; P =.04). During a mean follow-up of 3.1 ± 1.0 years, the annual mortality rate was increased in patients with postoperative troponin levels above the ULN (adjusted hazard ratio [HR] 1.43; 95% confidence interval [CI] 1.15-1.76; P =.001) irrespective of DT or no DT. Likewise, patients with elevated troponin levels had a significantly higher risk of arrhythmic death (adjusted HR 1.80; 95% CI 1.23-2.63; P =.002). The rate of first appropriate ICD shock (adjusted HR 0.89; 95% CI 0.71-1.12; P =.32) or failed appropriate shock (adjusted HR 1.02; 95% CI 0.59-1.76; P =.95) was similar in patients with or without troponin elevation. Conclusion DT at the time of ICD implantation is associated with increased troponin levels, indicating subclinical myocardial injury caused by the procedure. Elevated troponin levels but not DT seem to predict clinical outcomes in ICD recipients.

KW - Defibrillation testing

KW - Implantable cardioverter-defibrillator

KW - Mortality

KW - Troponin I

KW - Troponin T

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