Effect of Serelaxin on Mode of Death in Acute Heart Failure Results From the RELAX-AHF Study
Effect of Serelaxin on Mode of Death in Acute Heart Failure Results From the RELAX-AHF Study
复制标题
DOI：
10.1016/j.jacc.2014.05.071
复制
发表时间：
2014-10-14
影响因子：
24
通讯作者：
Metra, Marco
中科院分区：
文献类型：
--
作者：
Felker, G. Michael;Teerlink, John R.;Metra, Marco
背景人们对急性心力衰竭（AHF）住院后的死亡方式知之甚少。在 RELAX-AHF（松弛素治疗急性心力衰竭的功效和安全性）研究中，serelaxin（人松弛素 2 的重组形式）降低了选定的 AHF 患者出院后 180 天的死亡率。 目的 本研究的目的是评估 serelaxin 对 AHF 患者特定死亡模式的影响。 方法 RELAX-AHF 研究将 1,161 名 AHF 患者随机分为两组静脉注射 Serelaxin 或安慰剂治疗 48 小时。对患者的生命状态进行了 180 天的随访。盲法临床事件委员会审查了所有死亡事件，并根据预先指定的标准判定死因。根据预先指定的死亡模式分组，使用 Cox 比例风险模型评估 Serelaxin 对每种死亡模式的影响。 结果 共有 107 例死亡 (9.3%)：37 例 (35%) 因心力衰竭，25 例 (23%) 因猝死，15 例 (14%) 因其他心血管 (CV) 原因，19 例 (18%) 因非 CV 原因，11 例死亡。 (10%) 分类为未知。 Serelaxin 对其他心血管死亡（风险比 [HR]：0.29；95% CI：0.12 至 0.73；p = 0.005）和猝死（HR：0.46；95% CI：0.20 至 1.07；p = 0.065）的治疗效果最为明显。 Serelaxin 治疗对心力衰竭死亡或非心血管死亡没有明显影响。 结论 在 RELAX-AHF 研究中，serelaxin 对死亡率的影响主要是由其他心血管原因死亡率和猝死的降低所驱动，对心力衰竭死亡没有明显影响。 （松弛素治疗急性心力衰竭的功效和安全性[RELAX-AHF]；
BACKGROUND Little is known about mode of death after acute heart failure (AHF) hospitalization. In the RELAX-AHF (Efficacy and Safety of Relaxin for the Treatment of Acute Heart Failure) study, serelaxin, the recombinant form of human relaxin-2, reduced post-discharge mortality at 180 days in selected patients with AHF.OBJECTIVES The goal of this study was to assess the effect of serelaxin on specific modes of death in patients with AHF.METHODS The RELAX-AHF study randomized 1,161 patients with AHF to 48 h of therapy with intravenous serelaxin or placebo. Patients were followed for vital status through 180 days. A blinded clinical events committee reviewed all deaths and adjudicated a cause of death on the basis of pre-specified criteria. Cox proportional hazard models were used to assess the effect of serelaxin on each mode of death, on the basis of pre-specified groupings of mode of death.RESULTS There were 107 deaths (9.3%): 37 (35%) due to HF, 25 (23%) due to sudden death, 15 (14%) due to other cardiovascular (CV) causes, 19 (18%) due to non-CV causes, and 11 (10%) classified as unknown. The treatment effect of serelaxin was most pronounced on other CV deaths (hazard ratio [HR]: 0.29; 95% CI: 0.12 to 0.73; p = 0.005) and sudden death (HR: 0.46; 95% CI: 0.20 to 1.07; p = 0.065). There was no apparent impact of serelaxin treatment on HF deaths or non-CV deaths.CONCLUSIONS In the RELAX-AHF study, the effects of serelaxin on mortality were primarily driven by reduction in mortality from other CV causes and sudden death, without apparent impact on HF deaths. (Efficacy and Safety of Relaxin for the Treatment of Acute Heart Failure [RELAX-AHF];