Résumé
Introduction While the subcutaneous implantable cardioverter defibrillator (S-ICD) is now an established strategy to prevent sudden cardiac death, the specificities and outcomes associated with the use of this device in women have never been assessed so far.Objective The present study aimed to provide contemporary real-world data on S-ICD use and outcomes in women.Method We used data from the HONEST cohort, a nationwide study including all patients implanted with a S-ICD between 2012 and 2019 in France. Sex-specific outcomes were acceded using a weighting propensity score analysis.Results A total of 1148 women (47.3 ± 15.6 years), accounting for 23.3% of the whole cohort (n = 4924), were enrolled. Indication of implantation was primary prevention in 57.6% (vs. 65.1% in men) and secondary prevention in 42.4% (vs. 34.9% in men; P < 0.009). Coronary artery disease was the most frequent underlying heart disease (38.9% vs. 56.5% in men) and electrical heart disorders were more common in women (26.4% vs. 20.5%; P < 0.001). During a mean follow up of 4.22 ± 2.18 years, women did not have a higher risk of overall complications (aHR 0.95; 95%CI 0.89–1.01; P = 0.065), and of surgical reintervention (aHR 0.95, 95%CI 0.89–1.02, P = 0.094) (Fig. 1). Re-intervention due to pacing need occurred similarly in both sexes (2.4% vs. 2.8%; P = 0.434). Conversely, the risk of inappropriate (aHR 0.81; 95% 0.71–0.91; P < 0.001) and appropriate shocks (aHR 0.91; 95%CI 0.82–1.00; P = 0.045) was lower in women. Finally, there was no difference in risk of death between genders (aHR 1.00; 95%CI 0.97–1.02; P = 0.790).Conclusion This nationwide multicenter cohort study of S-ICD patients showed significant sex-related differences in patient characteristics and outcomes, with a lower risk of appropriate and inappropriate shocks in women as compared with men.