......................................................................................................................................................................................... ......................................................................................................................................................................................... Characteristics and factors associated to patients discharging from hospital without an implantable cardioverter defibrillator after out-of-hospital cardiac arrest Ardalan Sharifzadehgan 1,2,3 *, Bamba Gaye 2,3 , Julien Rischard 1,2 , Wulfran Bougouin 2,3,4 , Nicole Karam 1,2,3 , Victor Waldmann 1,2,3 , Kumar Narayanan 2,5 , Florence Dumas 2,3,6 , Estelle Gandjbakhch 7,8 , Vincent Algalarrondo 8,9 , Frankie Beganton 2 , Fabrice Extramiana 8,9 , Nicolas Lellouche 8,10 , Lionel Lamhaut 2,3,11 , Daniel Jost 2,12 , Alain Cariou 2,3,13 , Xavier Jouven 1,2,3 **, Eloi Marijon 1,2,3,8 **, and on behalf of the Paris-SDEC investigators † 1 European Georges Pompidou Hospital, Cardiology Department, Paris, France; 2 Paris-Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France; 3 Université Paris Cité, Paris, France; 4 Jacques Cartier Hospital, Intensive Care Unit, Massy, France; 5 Medicover Hospitals, Cardiology Department, Hyderabad, India; 6 Cochin Hospital, Emergency Department, Paris, France; 7 La Pitié Salpêtrière University Hospital, Cardiology Department, Paris, France; 8 Groupe Parisien Universitaire de Rythmologie (G.P.U.R.), Paris, France; 9 Bichat-Claude-Bernard Hospital, Cardiology Department, Paris, France; 10 University Hospital Henri Mondor, Cardiology Department, Crèteil, France; 11 Emergency Medical Services (SAMU) 75, Necker University Hospital, APHP, Paris, France; 12 Paris Firefighters Brigade (BSPP), Paris, France; and 13 Cochin Hospital, Intensive Care Unit, Paris, France Received 25 February 2022; revised 25 April 2022; editorial decision 16 May 2022; accepted 17 May 2022; online publish-ahead-of-print 17 June 2022 Aims Guidelines recommend that in the absence of reversible cause for sudden cardiac arrest (SCA), implantable cardioverter defibrillator (ICD) should be performed to prevent further fatal event. We sought to describe the frequency and char- acteristics of patients discharged from the hospital without ICD after the SCA in the daily practice. Methods and results From 2011 to 2018, all SCAs related to a cardiac cause admitted alive across the 48 hospitals of Great Paris Area were prospectively enrolled. Two investigators thoroughly reviewed each medical report to ensure accuracy of the assigned diagnosis towards identifying the cause of SCA and ICD implantation. Out of the 4314 SCA admitted alive at hospital admission, 1064 cardiac-related SCA survivors were discharged alive from hospital, including 356 patients (33.5%) with an ICD and 708 (66.5%) without. The principal underlying cause of SCA among those discharged without an ICD was acute coronary syndrome (ACS; 602, 85%), chronic coronary artery disease (41, 5.8%), structural non-ischae- mic heart disease (48, 6.8%), and non-structural heart disease (17, 2.4%). Among ACS-related SCA, 93.8% (602/642) discharged without an ICD. The unique factor associated with non-ICD implantation in the setting of ACS was immediate coronary angioplasty (odds ratio 4.22, 95% confidence interval 1.86–9.30, P , 0.001). Conclusion Two-thirds of SCA survivors were discharged without an ICD, mainly in the setting of ACS. The unique factor associated with non-ICD implantation among ACS was immediate coronary angioplasty emphasizing the fact that ACS definition must be precise since associated with ICD implantation or not. ------------------------------------------------------------------------------------------------------------------------------------------------------------ Keywords Sudden death • Risk stratification • Implantable cardioverter defibrillator • Guidelines • Acute coronary syndrome * Corresponding author. Tel: +33 6 7567 9292, Fax: +33 1 5609 3047. Email: ardalan.shar@gmail.com ** Xavier Jouven and Eloi Marijon contributed equally. † The names of the investigators of the Paris-SDEC are listed in Supplementary material online, Appendix. © The Author(s) 2022. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please email: journals.permissions@oup.com. European Heart Journal: Acute Cardiovascular Care (2022) 11, 523–531 https://doi.org/10.1093/ehjacc/zuac065 ORIGINAL SCIENTIFIC PAPER Acute Coronary Syndromes Downloaded from https://academic.oup.com/ehjacc/article/11/7/523/6609958 by guest on 22 July 2022