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Sex differences among subcutaneous implantable cardioverter-defibrillator recipients: a propensity-matched, multicentre, international analysis from the i-SUSI project

Women have been historically underrepresented in implantable cardioverter-defibrillator (ICD) trials. No data on sex differences regarding subcutaneous ICDs (S-ICD) carriers have been described. Aim of our study was to investigate sex-related differences among unselected S-ICD recipients.Consecutive...

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Main Authors: Schiavone, Marco (Author) , Gasperetti, Alessio (Author) , Vogler, Julia (Author) , Compagnucci, Paolo (Author) , Laredo, Mikael (Author) , Breitenstein, Alexander (Author) , Gulletta, Simone (Author) , Martinek, Martin (Author) , Kaiser, Lukas (Author) , Tundo, Fabrizio (Author) , Palmisano, Pietro (Author) , Rovaris, Giovanni (Author) , Curnis, Antonio (Author) , Kuschyk, Jürgen (Author) , Biffi, Mauro (Author) , Tilz, Roland (Author) , Di Biase, Luigi (Author) , Tondo, Claudio (Author) , Forleo, Giovanni B (Author)
Format: Article (Journal)
Language:English
Published: May 2024
In: Europace
Year: 2024, Volume: 26, Issue: 5, Pages: 1-10
ISSN:1532-2092
DOI:10.1093/europace/euae115
Online Access:Verlag, kostenfrei, Volltext: https://doi.org/10.1093/europace/euae115
Verlag, kostenfrei, Volltext: https://academic.oup.com/europace/article/26/5/euae115/7663397
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Author Notes:Marco Schiavone, Alessio Gasperetti, Julia Vogler, Paolo Compagnucci, Mikael Laredo, Alexander Breitenstein, Simone Gulletta, Martin Martinek, Lukas Kaiser, Fabrizio Tundo, Pietro Palmisano, Giovanni Rovaris, Antonio Curnis, Jürgen Kuschyk, Mauro Biffi, Roland Tilz, Luigi Di Biase, Claudio Tondo, Giovanni B Forleo, i-SUSI investigators

MARC

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520 |a Women have been historically underrepresented in implantable cardioverter-defibrillator (ICD) trials. No data on sex differences regarding subcutaneous ICDs (S-ICD) carriers have been described. Aim of our study was to investigate sex-related differences among unselected S-ICD recipients.Consecutive patients enrolled in the multicentre, international i-SUSI registry were analysed. Comparisons between sexes were performed using a 1:1 propensity matching adjusted analysis for age, body mass index (BMI), left ventricular function, and substrate. The primary outcome was the rate of appropriate shocks during follow-up. Inappropriate shocks and other device-related complications were deemed secondary outcomes. A total of 1698 patients were extracted from the i-SUSI registry; 399 (23.5%) were females. After propensity matching, two cohorts of 374 patients presenting similar baseline characteristics were analysed. Despite similar periprocedural characteristics and a matched BMI, women resulted at lower risk of conversion failure as per PRAETORIAN score (73.4% vs. 81.3%, P = 0.049). Over a median follow-up time of 26.5 [12.7-42.5] months, appropriate shocks were more common in the male cohort (rate/year 3.4% vs. 1.7%; log-rank P = 0.049), while no significant differences in device-related complications (rate/year: 6.3% vs. 5.8%; log-rank P = 0.595) and inappropriate shocks (rate/year: 4.3% vs. 3.1%; log-rank P = 0.375) were observed. After controlling for confounders, sex remained significantly associated with the primary outcome (aHR 1.648; CI 0.999-2.655, P = 0.048), while not resulting predictor of inappropriate shocks and device-related complications.In a propensity-matched cohort of S-ICD recipients, women are less likely to experience appropriate ICD therapy, while not showing higher risk of device-related complications.ClinicalTrials.gov Identifier: NCT0473876. 
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