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Heart:ICD可为等待心脏移植者带来生存获益

来源:cmt 2013-07-19 10:42

瑞士一项研究表明,置入型心律转复除颤器(ICD)可对等待心脏移植的终末期心衰患者产生即刻和持续的生存益处。论文6月27日在线发表于《心脏》(Heart)。

此项研究共纳入1089例等待心脏移植的终末期心衰患者,其中550例(51%)接受ICD治疗,因心源性猝死一级和二级预防而置入者分别为216和334例。对置入和未置入ICD的患者进行全因死亡率对比。

结果显示,尽管心脏移植中位等待时间仅为8个月,但与未置入ICD的患者相比,置入ICD的患者与其全因死亡率减少具有相关性(P=0.0001)。对年龄、性别、潜在心脏病、房颤、心脏再同步治疗、NYHA分级、射血分数、复合用药和等待时间进行校正之后,Cox风险回归模型显示ICD的独立有益影响在因一级预防而置入的患者最为显着(HR 0.4;P=0.016)。(生物谷Bioon.com)

生物谷推荐英文摘要:

Heart                  doi:10.1136/heartjnl-2013-304185

Prophylactic implantable cardioverter defibrillator treatment in patients with end-stage heart failure awaiting heart transplantation

Georg M Frohlich, Johannes Holzmeister, Michael Hübler, Samira Hübler, Mathias Wolfrum1, Frank Enseleit, Burkhardt Seifert, David Hürlimann, Hans B Lehmkuhl, Georg Noll, Jan Steffel, Volkmar Falk, Thomas F Lüscher, Roland Hetzer, Frank Ruschitzka

Objectives This study was designed to delineate the role of implantable cardioverter defibrillator (ICD) therapy for the primary and secondary prevention of sudden cardiac death in patients listed for heart transplantation.

Setting Retrospective observational multicentre study.

Patients 1089 consecutive patients listed for heart transplantation in two tertiary heart transplant centres were enrolled. Of 550 patients (51%) on the transplant list with an ICD, 216 had received their ICD for the primary prevention of sudden cardiac death and 334 for secondary prevention. 539 patients did not receive an ICD.

Intervention Treatment with or without an ICD was left to the discretion of the heart failure specialist.

Main outcome measure All-cause mortality.

Results ICDs appear to be associated with a reduction in all-cause mortality in patients implanted with the device for primary and secondary prevention compared to those without an ICD despite a median time on the waiting list of only 8?months (estimated 1-year: 88±3% vs 77±3% vs 67±3%; p=0.0001). A Cox regressional hazard model (corrected for age, sex, underlying heart disease, atrial fibrillation, cardiac resynchronisation therapy, New York Heart Association (NYHA) class, ejection fraction, co-medication and year of listing) suggested an independent beneficial effect of ICDs that was most pronounced in patients who had received an ICD for primary prevention (HR 0.4, 95% CI 0.19 to 0.85; p=0.016).

Conclusions ICD implantation appears to be associated with an immediate and sustained survival benefit for patients awaiting heart transplantation.

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