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【NEJM】除颤器电击对心力衰竭患者预后的重要性
Jeanne E. Poole, M.D., George W. Johnson, B.S.E.E., Anne S. Hellkamp, M.S., Jill Anderson, R.N., David J. Callans, M.D., Merritt H. Raitt, M.D., Ramakota K. Reddy, M.D., Francis E. Marchlinski, M.D., Raymond Yee, M.D., Thomas Guarnieri, M.D., Mario Talajic, M.D., David J. Wilber, M.D., Daniel P. Fishbein, M.D., Douglas L. Packer, M.D., Daniel B. Mark, M.D., M.P.H., Kerry L. Lee, Ph.D., and Gust H. Bardy, M.D.
ABSTRACT
Background Patients with heart failure who receive an implantable cardioverter–defibrillator (ICD) for primary prevention (i.e., prevention of a first life-threatening arrhythmic event) may later receive therapeutic shocks from the ICD. Information about long-term prognosis after ICD therapy in such patients is limited.
Methods Of 829 patients with heart failure who were randomly assigned to ICD therapy, we implanted the ICD in 811. ICD shocks that followed the onset of ventricular tachycardia or ventricular fibrillation were considered to be appropriate. All other ICD shocks were considered to be inappropriate.
Results Over a median follow-up period of 45.5 months, 269 patients (33.2%) received at least one ICD shock, with 128 patients receiving only appropriate shocks, 87 receiving only inappropriate shocks, and 54 receiving both types of shock. In a Cox proportional-hazards model adjusted for baseline prognostic factors, an appropriate ICD shock, as compared with no appropriate shock, was associated with a significant increase in the subsequent risk of death from all causes (hazard ratio, 5.68; 95% confidence interval [CI], 3.97 to 8.12; P<0.001). An inappropriate ICD shock, as compared with no inappropriate shock, was also associated with a significant increase in the risk of death (hazard ratio, 1.98; 95% CI, 1.29 to 3.05; P=0.002). For patients who survived longer than 24 hours after an appropriate ICD shock, the risk of death remained elevated (hazard ratio, 2.99; 95% CI, 2.04 to 4.37; P<0.001). The most common cause of death among patients who received any ICD shock was progressive heart failure.
Conclusions Among patients with heart failure in whom an ICD is implanted for primary prevention, those who receive shocks for any arrhythmia have a substantially higher risk of death than similar patients who do not receive such shocks.
Prognostic Importance of Defibrillator Shocks in Patients with Heart Failure
除颤器电击对心力衰竭患者预后的重要性
ABSTRACT
摘要：
Background Patients with heart failure who receive an implantable cardioverter–defibrillator (ICD) for primary prevention (i.e., prevention of a first life-threatening arrhythmic event) may later receive therapeutic shocks from the ICD. Information about long-term prognosis after ICD therapy in such patients is limited.
背景：接受埋藏式心脏电复律除颤器（ICD）进行一级预防（即预防首次威胁生命的心律失常事件）心力衰竭患者可能在此后接受来自ICD的治疗性电击。对于这类病人ICD治疗后的长期预后，我们了解的还很少。
Methods Of 829 patients with heart failure who were randomly assigned to ICD therapy, we implanted the ICD in 811. ICD shocks that followed the onset of ventricular tachycardia or ventricular fibrillation were considered to be appropriate. All other ICD shocks were considered to be inappropriate.
方法：在随机分配接受ICD治疗的829例心力衰竭患者中，我们对811例患者植入了ICD。室性心动过速或心室颤动后的ICD电击被认为是适当的电击。所有其它的ICD电击都被认为是不适当的电击。
Results Over a median follow-up period of 45.5 months, 269 patients (33.2%) received at least one ICD shock, with 128 patients receiving only appropriate shocks, 87 receiving only inappropriate shocks, and 54 receiving both types of shock. In a Cox proportional-hazards model adjusted for baseline prognostic factors, an appropriate ICD shock, as compared with no appropriate shock, was associated with a significant increase in the subsequent risk of death from all causes (hazard ratio, 5.68; 95% confidence interval [CI], 3.97 to 8.12; P<0.001). An inappropriate ICD shock, as compared with no inappropriate shock, was also associated with a significant increase in the risk of death (hazard ratio, 1.98; 95% CI, 1.29 to 3.05; P=0.002). For patients who survived longer than 24 hours after an appropriate ICD shock, the risk of death remained elevated (hazard ratio, 2.99; 95% CI, 2.04 to 4.37; P<0.001). The most common cause of death among patients who received any ICD shock was progressive heart failure.
结果：在平均随访45.5个月后，269例患者(33.2%)接受了至少1次ICD电击，128例患者仅接受了适当的电击，87例患者仅接受了不适当电击，54例患者接受了适当和不适当的电击。采用Cox比例风险模型分析校正了基线预后影响因子后，适当的ICD电击，与没有适当的电击相比，与随后的全因死亡风险增加显著相关（危险比5.68，95%可信区间3.97-8.12，P<0.001）。不适当电击，与没有不适当电击相比，与死亡风险增加显著相关（危险比1.98，95%可信区间1.29-3.05，P=0.002）。对于在适当的ICD电击后生存超过24小时的患者，死亡的风险仍然升高（2.99，95%可信区间2.04-4.37，P<0.001）。接受了任何ICD电击的患者死亡的主要原因是进展性心力衰竭。
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作者:admin@医学,生命科学 2010-11-03 17:11
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