Mortality after cardioverter-defibrillator replacement: results of the DECODE SUrvival SCore Index (DECODE-SUSCI).

Abstract Background Device replacement is the ideal time to reassess health care goals regarding continuing ICD therapy. Only few data are available on the decision making at this time. Objective To identify factors associated with poor prognosis at the time of ICD replacement and to develop a prognostic index able to stratify those patients at risk of dying early. Methods Detect long-term complications after ICD replacement (DECODE) was a prospective, single-arm, multicenter cohort study aimed at estimating long-term complications in a large population of patients who underwent ICD/CRT-D replacement. Potential predictors of death were investigated, and all these factors were gathered into a survival score index (SUSCI). Results We included 983 consecutive patients (median age 71 years, 76% male, 55% ischemic, 47% CRT-D). During a median follow-up time of 761[628-904] days, 114 (12%) patients died. At multivariate Cox regression analysis NYHA class III/IV, Ischemic cardiomyopathy, BMI Conclusions A simple score that includes a limited set of variables appears to be predictive for total mortality in an unselected, real-world population undergoing ICD replacement. Evaluation of the patient's profile may assist in predicting vulnerability and should prompt individualized options, especially for high-risk patients.