P605Appropriate shocks and mortality in diabetic vs. non-diabetic patients with prophylactic implantable cardioverter-defibrillator

Background: 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 diabetic vs. non-diabetic patients with implanted prophylactic cardioverter-defibrillator (ICD) included in the retrospective EU-CERT study. Methods and results: A total of 3535 patients from 12 European centers with a mean age of 63.7±11.2 (82% males) at the time of ICD implantation were included in the analysis. A total of 995 patienst (28%) had the history of diabetes. All patients had ICD implanted for primary prophylaxis. End-points were appropriate shock and all-cause mortality. Analyses were performed using a competing risk model stratified by study site, based on the proportional subdistribution model by Fine and Gray. First, parameters were tested in a univariate model and all variables with a significant effect were included in a multivariate model. Mean follow-up time was 3.2±2.3 years. Diabetes was associated with a lower risk of appropriate shocks in univariate analysis with a hazard ratio (HR) of 0.80 (95% CI; 0.65–0.99, p=0.047), and remained so in the multivariate analysis including age, etiology of heart disease (ischemic vs. non-ischemic), gender, and left ventricular ejection fraction in the model (HR; 0.77; 95% CI; 0.62–0.96, p=0.02). However, diabetic patients had a significantly higher mortality with a univariate HR 1.42 (95% CI; 1.21–1.67, p<0.001) and multivariate HR of 1.30 (95% CI; 1.11–1.53, p=0.001) including NYHA functional class in addition to variables above in the model.