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.

中文翻译：

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与没有糖尿病的预防性植入式心脏复律除颤器的患者相比，适当的电击和死亡率。

目的糖尿病会增加全因死亡率和心源性猝死（SCD）的风险。导致糖尿病猝死的确切机制尚不清楚。我们比较了回顾性EU-CERT-ICD登记册中包含的预防性植入式心脏复律除颤器（ICD）在有糖尿病和无糖尿病的情况下适当电击的发生率和死亡率。研究设计，方法和结果本研究纳入了来自12个欧洲EU-CERT-ICD中心的3,535名患者，ICD植入时的平均年龄为63.7±11.2岁（男性占82％）。共有995名患者（占28％）有糖尿病史。所有患者均植入了ICD以预防SCD。终点是适当的休克和全因死亡率。平均随访时间为3.2±2。3年。糖尿病与适当电击的风险较低相关（调整后的危险比[HR] 0.77 [95％CI 0.62-0.96]，P = 0.02）。但是，糖尿病患者的死亡率明显更高（校正后的HR 1.30 [95％CI 1.11-1.53​​]，P = 0.001）。结论糖尿病患者的全因死亡率高于患有原发性预防性ICD的非糖尿病患者。随后，糖尿病患者发生适当的ICD休克的几率较低，这表明过高的死亡率可能并非主要由室性快速性心律失常引起。这些发现提示预防性ICD治疗改善左心室功能受损的糖尿病患者生存的潜力受到限制。糖尿病患者的死亡率明显更高（校正后的HR 1.30 [95％CI 1.11-1.53​​]，P = 0.001）。结论糖尿病患者的全因死亡率高于患有原发性预防性ICD的非糖尿病患者。随后，糖尿病患者发生适当的ICD休克的几率较低，这表明过高的死亡率可能并非主要由室性快速性心律失常引起。这些发现提示预防性ICD治疗改善左心室功能受损的糖尿病患者生存的潜力受到限制。糖尿病患者的死亡率明显更高（校正后的HR 1.30 [95％CI 1.11-1.53​​]，P = 0.001）。结论糖尿病患者的全因死亡率高于患有原发性预防性ICD的非糖尿病患者。随后，糖尿病患者发生适当的ICD休克的几率较低，这表明过高的死亡率可能并非主要由室性快速性心律失常引起。这些发现表明，预防性ICD治疗改善左心室功能受损的糖尿病患者生存的潜力有限。糖尿病患者发生适当的ICD休克的几率较低，这表明过高的死亡率可能并非主要由室性快速性心律失常引起。这些发现表明，预防性ICD治疗改善左心室功能受损的糖尿病患者生存的潜力有限。糖尿病患者发生适当的ICD休克的几率较低，这表明过高的死亡率可能并非主要由室性快速性心律失常引起。这些发现提示预防性ICD治疗改善左心室功能受损的糖尿病患者生存的潜力受到限制。