P1480French experience of SICD implantation

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
J Proukhnitzky ◽  
N Badenco ◽  
E Gandjbakhch ◽  
C Maupain ◽  
X Waintraub ◽  
...  
Keyword(s):  
Procedure Time ◽  
Inappropriate Shock ◽  
Subcutaneous Icd ◽  
T Wave ◽  
Kaplan Meier ◽  
French Experience ◽  
Shock Impedance ◽  
Appropriate Shocks ◽  
Implantation Success

Abstract OnBehalf GPUR Introduction The subcutaneous ICD prevents complications of transvenous leads. Its implantation needs a defibrillation test. Performing this test increases the time of procedures.. Purpose The aim of our study is to describe the experience of subcutaneous ICD of Assitance Publique des Hopitaux de Paris (AP-HP). Materials and Methods In a retrospective cohort we included patients who were involved in subcutaneous ICD treatment at the 5 hospitals of AP-HP from December 2012 to April 2018.Analysis used the Kaplan-Meier method and the Mann-Whitney U test. Results 162 patients were implanted. 76% of implantations were for secondary prevention before 2017, but only 49% after 2017. 126 (77%) tests were successful at first shock, 14 (8.6%) needed a second shock or more, 9 (5.5%) did not have a test. The shock impedance was significantly higher when the shock was not effective at the first test, 82 ohms CI 95% [68; 112] versus 66 ohms CI 95% [64; 70], p <0.05. 6 patients died (3.7%). Late follow up showed 23 (10%) appropriate shocks and 24 inappropriate shocks (11%) mainly due to T wave oversensing (37.5%). Conclusions This is the first french experience of SICD implantation. Success of defibrillation test was lower than expected. Caracteristics of implantation General anesthesia (%) 162 (100) Procedure time (min) Mean ± SD (median)Range 73± 24 (60)20-165 Cameron Health (%) Generator SQ-RX ® 1010 12 (7.4) Boston Scientific (%) Generator EMBLEM ® A209 100 (61.7) Generator EMBLEM ® A219 44 (27.2) VF time (sec) Mean ± SD (median)Range 16.5± 3.4(15)10-37 Shock Impedance (ohm) Mean ± SD (median) Range 72 ± 12.7 (68) 42-130 Success at 1st shock (%) 126 (77.7) Success at 2nd shock or more (%) 14 (8.6) No test performed (%) 12 (7.4) Implantation caracteristics and defibrillation testing. Impedance was significantly higher in patients without success at first shock : 82 ohms CI 95% [68 ;112] vs 66 ohms CI 95% [64 ;70], p < 0.05. Abstract Figure. Survival without inappropriate shock

scholarly journals Impact of Moderate to Severe Renal Impairment on Mortality and Appropriate Shocks in Patients with Implantable Cardioverter Defibrillators

2010 ◽  
Vol 2010 ◽  
pp. 1-6 ◽  
Author(s):  
Venkata M. Alla ◽  
Kishlay Anand ◽  
Mandeep Hundal ◽  
Aimin Chen ◽  
Showri Karnam ◽  
...  
Keyword(s):  
Linear Models ◽  
Severe Renal Impairment ◽  
Medical Center ◽  
Implantable Cardioverter Defibrillators ◽  
Free Survival ◽  
Kaplan Meier ◽  
Appropriate Shocks ◽  
The Impact ◽  
Cardioverter Defibrillators

Background. Due to underrepresentation of patients with chronic kidney disease (CKD) in large Implantable-Cardioverter Defibrillator (ICD) clinical trials, the impact of ICD remains uncertain in this population.Methods. Consecutive patients who received ICD at Creighton university medical center between years 2000–2004 were included in a retrospective cohort after excluding those on maintenance dialysis. Based on baseline Glomerular filtration rate (GFR), patients were classified as severe CKD: GFR < 30 mL/min; moderate CKD: GFR: 30–59 mL/min; and mild or no CKD: GFR ≥ 60 mL/min. The impact of GFR on appropriate shocks and survival was assessed using Kaplan-Meier method and Generalized Linear Models (GLM) with log-link function.Results. There were 509 patients with a mean follow-up of 3.0 + 1.3 years. Mortality risk was inversely proportional to the estimated GFR: 2 fold higher risk with GFR between 30–59 mL/min and 5 fold higher risk with GFR < 30 mL/min. One hundred and seventy-seven patients received appropriate shock(s); appropriate shock-free survival was lower in patients with severe CKD (GFR < 30) compared to mild or no CKD group (2.8 versus 4.2 yrs).Conclusion. Even moderate renal dysfunction increases all cause mortality in CKD patients with ICD. Severe but not moderate CKD is an independent predictor for time to first appropriate shock.

Thinking about the future – data on adolescent patients with a subcutaneous ICD

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
K Willy ◽  
F Reinke ◽  
B Rath ◽  
N Boegeholz ◽  
J Wolfes ◽  
...  
Keyword(s):  
Sudden Cardiac Death ◽  
Children And Adolescents ◽  
Cardiac Death ◽  
Inappropriate Therapy ◽  
Single Center ◽  
Inappropriate Shock ◽  
Shock Delivery ◽  
T Wave

Abstract Background Implantable cardioverter-defibrillator (ICD) systems are established for the prevention of sudden cardiac death. Long-term data on ICD function in children and adolescents is rare and has suggested higher rates of lead failure as well as oversensing, both leading to inappropriate therapy. The present study displays a long-term single-center follow-up of young patients having received an S-ICD. Methods and results The present study represents a single-center experience of patients younger than 25 years who received an S-ICD (n=49). Follow-up data included regular in-house follow-up as well as unscheduled hospitalisations in our center. Mean age at implantation was 19.2±4.1 years and 33 patients (67.4%) were male. In 21 patients (42.9%) electrical heart disease or idiopathic ventricular fibrillation represented the underlying condition of ICD implantation. 15 patients suffered from HCM (30.6%). Median follow-up duration was 2 years. No patient died during the observation period. Appropriate shocks occurred in 7 patients (14.3%). Inappropriate shock delivery was recorded in 6 patients (12.3%). T-wave oversensing was the main cause for inappropriate shock delivery (5/6 patients), in the other patient myopotentials were the reason for inappropriate therapy. In one patient, operative refixation of the subcutaneous lead was necessary due to hypermobility leading to oversensing. After modification of the sensing vector as well as activation of the SMART pass filter no further oversensing episodes occurred in any patient. Conclusion ICD therapy in children and adolescents is effective for prevention of sudden cardiac death. Every episode was terminated by the first therapy. The rate of appropriate shock as well as inappropriate therapies was quite high compared to typical ICD cohorts. In particular T-wave oversensing seems to be challenging for the S-ICD detection algorithms also in this cohort. Funding Acknowledgement Type of funding source: None

Five year outcomes of the subcutaneous implantable cardioverter-defibrillator EFFORTLESS (evaluation of factors impacting clinical outcome and cost effectiveness of the S-ICD) registry

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
P Lambiase ◽  
DAMJ Theuns ◽  
FD Murgatroyd ◽  
CS Barr ◽  
L Eckardt ◽  
...  
Keyword(s):  
Implantable Cardioverter Defibrillator ◽  
Biventricular Pacing ◽  
Total System ◽  
Private Company ◽  
Pass Filter ◽  
Cardioverter Defibrillator ◽  
T Wave ◽  
Kaplan Meier ◽  
Wide Range

Abstract Funding Acknowledgements Type of funding sources: Private company. Main funding source(s): Boston Scientific OnBehalf EFFORTLESS Registry Introduction Patients (pts) implanted with transvenous (TV) implantable cardioverter-defibrillator (ICD) experience complications (Cx) associated with TV leads and inappropriate shocks (IAS) for atrial fibrillation (AF) or other supraventricular tachycardias (SVT). The EFFORTLESS S-ICD Registry is a 5-year (yr) follow-up (f/u) study of pts implanted with the subcutaneous ICD (S-ICD). Purpose To report on the 5-yr outcomes of pts with a wide range of S-ICD indications implanted with early generation devices. Methods Pts were enrolled at 43 centers February 2011-December 2014. Kaplan-Meier Cx, appropriate shock (AS), and IAS rates are reported. Results 994 pts (495 retrospective) were enrolled in the EFFORTLESS study and 984 pts (28% female, 48 ± 17 yrs, BMI 27 ± 6 kg/m2, ejection fraction 43 ± 18%) underwent S-ICD implantation. Mean study f/u was 4.4 ± 1.6 yrs. The pt cohort had diverse etiologies: 31% ischemic heart disease, 19% non-ischemic cardiomyopathy, 11% hypertrophic cardiomyopathy, 17% channelopathies, and 20% of pts miscellaneous. Total system- and procedure-related Cx (table) were 9.4% at 5 yrs. AS and IAS rates at 5 yrs were 15.9% and 16.9%, respectively and the IAS rates for AF/SVT and t wave oversensing were 3.1% and 5.8%, respectively. More pts experienced Cx and IAS in the first yr than in yrs 2-5 altogether (8.7 vs 8.2%), the most common as a result of discomfort/erosion (38%), IAS (26%), system infection (9%), and premature battery depletion (9%). Of these late Cx, 74% were experienced by retrospective pts. Spontaneous conversion efficacy for the first shock and final shocks was 89.7% and 97.7%. Of the 91 (9.2%) deaths reported, none were associated with the S-ICD system or procedure. Cause of death was cardiac for 40 pts, non-cardiac for 40 pts, other for 4 pts, and unknown for 7 pts. Only 20 (2.0%) pts had their S-ICD replaced for a TV device for pacing: 4 bradycardia, 7 anti-tachycardia, and 9 for biventricular pacing. Conclusions The EFFORTLESS registry provides 5-year follow-up for a diverse, large, multinational S-ICD registry. Complications primarily occurred in the first year but remained low through 5 years. Inappropriate shock rates were typically observed in older generation devices prior to introduction of the SMART Pass filter. Replacement for TV-ICD due to the need for pacing was rare. Outcome 30 day 1 yr 2 yr 3 yr 4 yr 5yr Annual Complications (Kaplan-Meier) 2.0 5.3 6.8 7.6 8.6 9.4 1.9 IAS, overall (Kaplan-Meier) 1.7 8.7 11.6 13.1 14.6 16.9 3.4 IAS, t wave oversensing 3.4 5.8 1.2

scholarly journals Efficacy and Safety of Appropriate Shocks and Antitachycardia Pacing in Transvenous and Subcutaneous Implantable Defibrillators: An Analysis of All Appropriate Therapy in the PRAETORIAN trial

Circulation ◽  
2021 ◽  
Author(s):  
Reinoud E. Knops ◽  
Willeke van der Stuijt ◽  
Peter Paul H.M. Delnoy ◽  
Lucas V.A. Boersma ◽  
Juergen Kuschyk ◽  
...  
Keyword(s):  
Secondary Analysis ◽  
Antitachycardia Pacing ◽  
Icd Therapy ◽  
Intention To Treat ◽  
Kaplan Meier ◽  
Appropriate Shocks ◽  
Appropriate Therapy ◽  
To Receive ◽  
Treat Population

Background: The PRAETORIAN trial showed non-inferiority of the subcutaneous implantable cardioverter-defibrillator (S-ICD) compared to the transvenous ICD (TV-ICD) with regard to inappropriate shocks and complications. In contrast to the TV-ICD, the S-ICD cannot provide antitachycardia pacing (ATP) for monomorphic ventricular tachycardia (VT). This pre-specified secondary analysis evaluates appropriate therapy and whether ATP reduces the number of appropriate shocks. Methods: The PRAETORIAN trial was an international, investigator-initiated randomized trial, which included patients with an indication for ICD therapy. Patients with prior VTs below 170 bpm or refractory recurrent monomorphic VTs were excluded. In 39 centers, 849 patients were randomized to receive an S-ICD (N=426) or TV-ICD (N=423) and were followed for a median of 49.1 months. ICD programming was mandated by protocol. Appropriate ICD therapy was defined as therapy for ventricular arrhythmias. Arrhythmias were classified as discrete episodes and storm episodes (≥3 episodes within 24 hours). Analyses were performed in the modified intention-to-treat population. Results: In the S-ICD group, 86/426 patients received appropriate therapy, versus 78/423 patients in the TV-ICD group, during a median follow-up of 52 months (48-month Kaplan-Meier estimates 19.4% and 17.5%, P=0.45). In the S-ICD group, 83 patients received at least one shock, versus 57 patients in the TV-ICD group (48-month Kaplan-Meier estimates 19.2% and 11.5%, P=0.02). Patients in the S-ICD group had a total of 254 shocks, compared to 228 shocks in the TV-ICD group (P=0.68). First shock efficacy was 93.8% in the S-ICD group and 91.6% in the TV-ICD group (P=0.40). The first ATP attempt successfully terminated 46% of all monomorphic VTs, but accelerated the arrhythmia in 9.4%. Ten S-ICD patients experienced 13 electrical storms, versus 18 TV-ICD patients with 19 electrical storms. Patients with appropriate therapy had an almost two-fold increased relative risk of electrical storms in the TV-ICD group compared to the S-ICD group (P=0.05). Conclusions: In this trial, no difference was observed in shock efficacy of the S-ICD compared with the TV-ICD. Although patients in the S-ICD group were more likely to receive an ICD shock, the total number of appropriate shocks was not different between the two groups.

scholarly journals Incidence, mechanisms, and clinical impact of inappropriate shocks in patients with a subcutaneous defibrillator

EP Europace ◽  
2020 ◽  
Vol 22 (5) ◽  
pp. 761-768
Author(s):  
Boris Rudic ◽  
Erol Tülümen ◽  
Fabian Fastenrath ◽  
Susanne Röger ◽  
Diana Goranova ◽  
...  
Keyword(s):  
First Generation ◽  
Automatic Gain Control ◽  
Gain Control ◽  
Primary And Secondary Prevention ◽  
Inappropriate Shock ◽  
Subcutaneous Defibrillator ◽  
Inappropriate Shocks ◽  
T Wave ◽  
Primary Vector

Abstract Aims Inappropriate shocks (IAS) remain a challenge for patients and physicians after implantation of the subcutaneous implantable cardioverter-defibrillator (S-ICD). The aims were to assess and characterize different patterns of IAS. Methods and results Two hundred and thirty-nine patients were implanted with an S-ICD between 2010 and 2018 for primary and secondary prevention. Follow-up data of at least 6 months were analysed. During a mean follow-up of 34.9 ± 16.0 months, a total of 73 shocks occurred in 38 patients (6%). Forty-three (59%) shocks were considered appropriate due to ventricular tachycardia/ventricular fibrillation, while 30 (41%) were inappropriate and occurred in 19 patients (8%). Myopotentials/noise was the most frequent cause of inappropriate shocks (n = 8), followed by T-wave oversensing (n = 6) and undersensing of the QRS, resulting in adaptation of the automatic gain control and inappropriate shock (n = 5). Seventy-four percent of all IAS occurred on the primary vector, while no IAS occurred on the alternate vector. In seven of eight patients (88%), IAS related to myopotentials have occurred on the primary sensing vector. Multivariate analysis identified taller patients, primary sensing vector and first-generation S-ICD device as predictors for IAS. SMART pass effectively reduced the occurrence of IAS in the second-generation S-ICD system. Conclusion Inappropriate therapies are less frequently observed on the alternate vector. The primary vector seems to be unfavourable with regard to oversensing caused by myopotentials. Inappropriate shocks were associated with an increased rate of rehospitalization but not mortality. These observations have implications for the prevention of inappropriate S-ICD shocks.

Colorectal Liver Metastases - Does the Number of Lesions Determine the Sensibility of Resection?

Swiss Surgery ◽  
2000 ◽  
Vol 6 (1) ◽  
pp. 6-10
Author(s):  
Knoefel ◽  
Brunken ◽  
Neumann ◽  
Gundlach ◽  
Rogiers ◽  
...  
Keyword(s):  
Liver Metastases ◽  
Colorectal Liver Metastases ◽  
Rank Test ◽  
Log Rank Test ◽  
Kaplan Meier ◽  
Chirurgische Entfernung

Die komplette chirurgische Entfernung von Lebermetastasen bietet Patienten nach kolorektalem Karzinom die einzige kurative Chance. Es gibt jedoch eine, anscheinend unbegrenzte, Anzahl an Parametern, die die Prognose dieser Patienten bestimmen und damit den Sinn dieser Therapie vorhersagen können. Zu den am häufigsten diskutierten und am einfachsten zu bestimmenden Parametern gehört die Anzahl der Metastasen. Ziel dieser Studie war es daher die Wertigkeit dieses Parameters in der Literatur zu reflektieren und unsere eigenen Patientendaten zu evaluieren. Insgesamt konnte von 302 Patienten ein komplettes Follow-up erhoben werden. Die gebildeten Patientengruppen wurden mit Hilfe einer Kaplan Meier Analyse und konsekutivem log rank Test untersucht. Die Literatur wurde bis Dezember 1998 revidiert. Die Anzahl der Metastasen bestätigte sich als ein prognostisches Kriterium. Lagen drei oder mehr Metastasen vor, so war nicht nur die Wahrscheinlichkeit einer R0 Resektion deutlich geringer (17.8% versus 67.2%) sondern auch das Überleben der Patienten nach einer R0 Resektion tendenziell unwahrscheinlicher. Das 5-Jahres Überleben betrug bei > 2 Metastasen 9% bei > 2 Metastasen 36%. Das 10-Jahres Überleben beträgt bislang bei > 2 Metastasen 0% bei > 2 Metastasen 18% (p < 0.07). Die Anzahl der Metastasen spielt in der Prognose der Patienten mit kolorektalen Lebermetastasen eine Rolle. Selbst bei mehr als vier Metastasen ist jedoch gelegentlich eine R0 Resektion möglich. In diesen Fällen kann der Patient auch langfristig von einer Operation profitieren. Das wichtigere Kriterium einer onkologisch sinnvollen Resektabilität ist die Frage ob technisch und funktionell eine R0 Resektion durchführbar ist. Ist das der Fall, so sollte auch einem Patienten mit mehreren Metastasen die einzige kurative Chance einer Resektion nicht vorenthalten bleiben.

RESEARCH THE VALUE OF THE COMBINATION OF T WAVE ALTERNANS AND NT-PROBNT IN PREDICTING SUDDEN CARDIAC DEATH

2012 ◽  
pp. 74-83
Author(s):  
Anh Tien Hoang ◽  
Nhat Quang Nguyen
Keyword(s):  
Myocardial Infarction ◽  
Sudden Cardiac Death ◽  
Cardiac Death ◽  
Ventricular Arrhythmias ◽  
Healthy Person ◽  
Treadmill Test ◽  
T Wave ◽  
T Wave Alternans

Background: Decades of research now link TWA with inducible and spontaneous clinical ventricular arrhythmias. This bench-to-bedside foundation makes TWA, NT-ProBNP a very plausible index of susceptibility to ventricular arrythmia, and motivates the need to define optimal combination of TWA and NT-ProBNP in predicting ventricular arrythmia in myocardial infarction patients. We research this study with 2 targets: 1. To evaluate the role of TWA in predicting sudden cardiac death in myocardial infarction patients. 2. To evaluate the role of NT-ProBNP in predicting sudden cardiac death in myocardial infarction patients 3. Evaluate the role of the combined NT-ProBNP and TWA in predicting sudden cardiac death in myocardial infarction patients. Methods: Prospective study with follow up the mortality in 2 years: 71 chronic myocardial infarction patients admitted to hospital from 5/2009 to 5/20011 and 50 healthy person was done treadmill test to caculate TWA; ECG, echocardiography, NT-ProBNP. Results: Cut-off point of NT-ProBNP in predicting sudden cardiac death is 3168 pg/ml; AUC = 0,86 (95% CI: 0,72 - 0,91); Cut-off point of TWA in predicting sudden cardiac death is 107 µV; AUC = 0,81 (95% CI: 0,69 - 0,87); NT-ProBNP can predict sudden cardiac death with OR= 7,26 (p<0,01); TWA can predict sudden cardiac death with OR= 8,45 (p<0,01). The combined NT-ProBNP and TWA in predicting ventricular arrythmia in heart failure patients: OR= 17,91 (p<0,001). Conclusions: The combined NT-ProBNP and TWA have the best predict value of sudden cardiac death in myocardial infarction patients, compare to NT-ProBNP or TWA alone

P2549The cardiovascular predictors of clinical outcomes in patients after ischemic stroke of undetermined etiology

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A Bielecka-Dabrowa ◽  
P Gasiorek ◽  
A Sakowicz ◽  
M Banach
Keyword(s):  
Ischemic Stroke ◽  
Independent Predictor ◽  
Reference Group ◽  
Peak Velocity ◽  
Recurrent Stroke ◽  
Mitral Annular Velocity ◽  
Kaplan Meier ◽  
Unfavourable Prognosis ◽  
Undetermined Etiology

Abstract Purpose The study aimed to identify echocardiographic, hemodynamic and biochemical predictors of unfavourable prognosis after ischemic strokes of undetermined etiology (ESUS) in patients (pts) at age <65. Methods Out of 520 ischemic stroke pts we selected 64 pts diagnosed with ESUS [mean age 54 (SD: 47–58) years, 42% males] and additional 36 without stroke but with similar risk profile, which were treated as a reference group [age 53 (SD: 47–58) years, 61% males]. All pts underwent echocardiography, non-invasive assessment of hemodynamic parameters using SphygmoCor tonometer (Atcor Med., Australia), HDL subfraction distribution using Lipoprint (Quantimetrix) as well as measurements of selected biomarkers. Follow-up was 12 months. Results At 12-month follow-up 9% of patients had died, and recurrent ischemic stroke also occurred in 9% of patients - only in the ESUS group (Figure). Patients who died had significantly lower levels of LDL and HDL cholesterol (included HDL-8 and -9 subfractions) and higher level of triglicerides (p=0.01, p=0.01, and p=0.02; respectively), lower level of adiponectin (p=0.01), lower value of mean early diastolic (E') mitral annular velocity (p=0.04) and lower diastolic blood pressure (p=0.04). The atrial fibrillation (AF) occurred in 10% of pts during the 12 months (log-rang, p=0.254) (Figure). The log-rank test showed that ESUS group had a significantly poorer outcome of AF in the first 2 months after hospitalization compared to reference group (11% vs 5%, p=0.041). Based on a Kaplan-Meier analysis, the outcome of re-hospitalizationin the 1st year was 28% (18/64) in the ESUS group and 17% (6/36); log-rank, p=0.058. In the multivariate analysis mean early diastolic (E') mitral annular velocity (odds ratio [OR] 0.75, 95% confidence interval [CI]: 0.6–0.94; p=0.01) was significantly associated with CV hospitalizations assessed at 12-month follow-up. The only independent predictor of AF occurrence in the 12-month follow-up was lower value of Tissue Doppler-derived right ventricular systolic excursion velocity S' (OR 0.65, 95% Cl 0.45–0.93; p=0.01). The only independent predictor of recurrent stroke was the ratio of peak velocity of early diastolic transmitral flow to peak velocity of early diastolic mitral annular motion as determined by pulsed wave Doppler (E/E') (OR 0.75, 95% CI: 0.6–0.94; p=0.01). E/E' ratio was also independently associated with composite endpoint consisting of death, hospitalization and recurrent stroke (OR 1.90, 95% CI 1.1–3.2, p=0.01). Kaplan-Meier Analysis - survival and AF Conclusions The indices of diastolic dysfunction are significantly associated with unfavourable prognosis after ESUS. There is a robust role for outpatient cardiac monitoring especially during first 2 months after ESUS to detect potential AF. Acknowledgement/Funding The study was financed by research grants no. 502-03/5-139-02/502-54-229-18 of the Medical University of Lodz

scholarly journals P-Cresyl Sulfate Is a Valuable Predictor of Clinical Outcomes in Pre-ESRD Patients

2014 ◽  
Vol 2014 ◽  
pp. 1-7 ◽  
Author(s):  
Cheng-Jui Lin ◽  
Chi-Feng Pan ◽  
Chih-Kuang Chuang ◽  
Fang-Ju Sun ◽  
Duen-Jen Wang ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Cardiovascular Event ◽  
Cox Regression ◽  
Medical Center ◽  
Serum Biochemistry ◽  
Cox Regression Analysis ◽  
Kaplan Meier ◽  
Valuable Marker ◽  
Valuable Predictor

Background/Aims. Previous studies have reported p-cresyl sulfate (PCS) was related to endothelial dysfunction and adverse clinical effect. We investigate the adverse effects of PCS on clinical outcomes in a chronic kidney disease (CKD) cohort study.Methods. 72 predialysis patients were enrolled from a single medical center. Serum biochemistry data and PCS were measured. The clinical outcomes including cardiovascular event, all-cause mortality, and dialysis event were recorded during a 3-year follow-up.Results. After adjusting other independent variables, multivariate Cox regression analysis showed age (HR: 1.12,P=0.01), cardiovascular disease history (HR: 6.28,P=0.02), and PCS (HR: 1.12,P=0.02) were independently associated with cardiovascular event; age (HR: 0.91,P<0.01), serum albumin (HR: 0.03,P<0.01), and PCS level (HR: 1.17,P<0.01) reached significant correlation with dialysis event. Kaplan-Meier analysis revealed that patients with higher serum p-cresyl sulfate (>6 mg/L) were significantly associated with cardiovascular and dialysis event (log rankP=0.03, log rankP<0.01, resp.).Conclusion. Our study shows serum PCS could be a valuable marker in predicting cardiovascular event and renal function progression in CKD patients without dialysis.

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