Arrhythmia and Survival Outcomes Among Black Patients and White Patients With a Primary Prevention Defibrillator.
Arrhythmia and Survival Outcomes Among Black Patients and White Patients With a Primary Prevention Defibrillator.
复制标题
使用一级预防除颤器的黑人患者和白人患者的心律失常和生存结果。
DOI：
10.1161/circulationaha.123.065367
复制
发表时间：
2023
期刊：
影响因子：
37.8
通讯作者：
Goldenberg,Ilan
中科院分区：
文献类型：
--
作者：
Younis,Arwa;Ali,Sanah;Hsich,Eileen;Goldenberg,Ido;McNitt,Scott;Polonsky,Bronislava;Aktas,MehmetK;Kutyifa,Valentina;Wazni,OussamaM;Zareba,Wojciech;Goldenberg,Ilan
美国黑人患非缺血性心肌病（NICM）的风险高于白色美国人。我们的目的是评估植入式心律转复除颤器（ICD）的患者之间的快速性心律失常的风险差异。METHODSThe研究人群包括3895 ICD收件人在美国参加一级预防ICD试验。结局指标包括室性快速性心律失常（VTA）、房性快速性心律失常（ATA）、ICD治疗、VTA负荷（使用Andersen-Gill复发事件分析）、死亡和ICD的预期获益。对所有事件进行盲法裁定。比较了黑人患者与白色心肌病患者（缺血性和NICM）的结局，黑人患者更可能是女性（35%对22%）和年轻人（57±12岁对62±12岁），合并症的频率更高。在NICM中，黑人患者首次VTA、快速VTA、ATA以及适当和不适当ICD治疗的发生率较高（VTA ≥170 bpm，32% vs 20%; VTA ≥200 bpm，22% vs 14%; ATA，25% vs 12%;适当治疗，30% vs 20%;和不适当治疗，25% vs 11%;所有患者P<0.001）。多变量分析显示，NICM黑人患者发生所有类型心律失常或ICD治疗的风险较高（VTA ≥170 bpm，风险比[HR] 1.71; VTA ≥200 bpm，HR 1.58; ATA，HR 1.87;适当治疗，HR 1.62;不适当治疗，HR 1.86;所有患者P≤0.01）、快速性心律失常或治疗负担较高（VTA，HR 1.84;适当治疗，HR 1.84;两者P<0.001）和死亡风险较高（HR 1.92;P=0.014）。相反，在缺血性心肌病中，黑人患者和白色患者之间所有类型的快速性心律失常、ICD治疗或死亡的风险相似。黑人患者和白色患者从ICD implantation.CONCLUSIONSAmong与ICD的一级预防NICM患者，黑人患者相比，白色患者有较高的风险和负担的VTA，ATA和ICD治疗的生存率较低。尽管如此，ICD的总体受益仍保持不变，与白色患者相似。
BACKGROUNDBlack Americans have a higher risk of nonischemic cardiomyopathy (NICM) than White Americans. We aimed to evaluate differences in the risk of tachyarrhythmias among patients with an implantable cardioverter-defibrillator (ICD).METHODSThe study population comprised 3895 ICD recipients in the United States enrolled in primary prevention ICD trials. Outcome measures included ventricular tachyarrhythmia (VTA), atrial tachyarrhythmia (ATA), ICD therapies, VTA burden (using Andersen-Gill recurrent event analysis), death, and the predicted benefit of the ICD. All events were adjudicated blindly. Outcomes were compared between self-reported Black patients versus White patients with cardiomyopathy (ischemic and NICM).RESULTSBlack patients were more likely to be female (35% versus 22%) and younger (57±12 versus 62±12 years) with a higher frequency of comorbidities. In NICM, Black patients had a higher rate of first VTA, fast VTA, ATA, and appropriate and inappropriate ICD therapy (VTA ≥170 bpm, 32% versus 20%; VTA ≥200 bpm, 22% versus 14%; ATA, 25% versus 12%; appropriate therapy, 30% versus 20%; and inappropriate therapy, 25% versus 11%;P<0.001 for all). Multivariable analysis showed that Black patients with NICM experienced a higher risk of all types of arrhythmia or ICD therapy (VTA ≥170 bpm, hazard ratio [HR] 1.71; VTA ≥200 bpm, HR 1.58; ATA, HR 1.87; appropriate therapy, HR 1.62; inappropriate therapy, HR 1.86;P≤0.01 for all), higher burden of tachyarrhythmias or therapies (VTA, HR 1.84; appropriate therapy, HR 1.84;P<0.001 for both), and a higher risk of death (HR 1.92;P=0.014). In contrast, in ischemic cardiomyopathy, the risk of all types of tachyarrhythmia, ICD therapy, or death was similar between Black patients and White patients. Both Black patients and White patients derived a significant and similar benefit from ICD implantation.CONCLUSIONSAmong patients with NICM with an ICD for primary prevention, Black patients compared with White patients had a high risk and burden of VTA, ATA, and ICD therapies with a lower survival rate. Nevertheless, the overall benefit of the ICD was maintained and was similar to that of White patients.