Age and the Risk of Ventricular Tachyarrhythmia in Patients With an Implantable Cardioverter-Defibrillator.
Age and the Risk of Ventricular Tachyarrhythmia in Patients With an Implantable Cardioverter-Defibrillator.
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植入式心脏复律除颤器患者的年龄和室性快速心律失常的风险。
DOI：
10.1016/j.jacep.2022.11.020
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发表时间：
2023
期刊：
影响因子：
--
通讯作者：
Goldenberg,Ilan
中科院分区：
文献类型：
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作者：
Aktaş,MehmetK;Younis,Arwa;Saxena,Shireen;Diamond,Alexander;Ojo,Amole;Kutyifa,Valentina;Steiner,Hillel;Steinberg,JonathanS;Zareba,Wojciech;McNitt,Scott;Polonsky,Bronislava;Rosero,SpencerZ;Huang,DavidT;Goldenberg,Ilan
本研究的目的是按年龄分组评估室性心律失常(VTA)和ICD电击的风险，并评估VTA和死亡的竞争风险。方法本研究包括5个具有里程碑意义的ICD试验(MADIT[多中心自动除颤器植入试验]II、MADIT-RISK、MADIT-CRT[MADIT心脏再同步治疗]、MADIT-RIT[MADIT减少不适当的治疗]和RAID[雷诺齐用于植入心脏过速除颤器的高危患者])。结果65岁组、65岁至75岁组和75岁≥组患者3年内快速室速(室性心动过速或室颤)的累积发生率相似(17%vs15%)，而75岁的≥患者(10%)死亡的风险最低(P<；0.001)。结果65岁组、65岁至75岁组和≥75岁组在3年内发生快速VTA的累积发生率相似(17%比15%)，而在75岁组中最低(10%)(P<；0.001)。多变量精细和灰色分析显示，与65岁的患者相比，75岁(HR：0.6；95%CI：0.46-0.78；P<；0.001)的患者发生快速室上性心动过速的风险降低40%。在75岁的≥患者中，观察到一种风险逆转，即先前没有快速动静脉曲张的死亡风险超过发展快速动静脉动静脉曲张的风险。有非持续性室性心动过速病史、男性和存在非缺血性心肌病是预测75岁≥患者快速室性心动过速的危险因素。结论75岁≥患者发生室性心动过速和ICD休克的风险显著低于年轻患者。与快速VTA的风险相比，年龄增长与死亡风险更高相关，而年轻患者的情况正好相反。
BackgroundThe benefit of implantable cardioverter-defibrillators (ICDs) in elderly patients is controversial.ObjectivesThe aims of this study were to evaluate the risk for ventricular tachyarrhythmia (VTA) and ICD shocks by age groups and to assess the competing risk for VTA and death without prior VTA.MethodsThe study included 5,170 primary prevention ICD recipients enrolled in 5 landmark ICD trials (MADIT [Multicenter Automatic Defibrillator Implantation Trial] II, MADIT-Risk, MADIT-CRT [MADIT Cardiac Resynchronization Therapy], MADIT-RIT [MADIT Reduce Inappropriate Therapy], and RAID [Ranolazine in High-Risk Patients With Implanted Cardioverter-Defibrillator]). Fine and Gray regression analysis was used to evaluate the risk for fast VTA (ventricular tachycardia ≥200 beats/min or ventricular fibrillation) vs death without prior fast VTA in 3 prespecified age groups: <65, 65 to <75, and ≥75 years.ResultsThe cumulative incidence of fast VTA at 3 years was similar for patients <65 years of age and those 65 to <75 years of age (17% vs 15%) and was lowest among patients ≥75 years of age (10%) (P< 0.001). Multivariate Fine and Gray analysis showed a 40% lower risk for fast VTA in patients ≥75 years of age (HR: 0.60; 95% CI: 0.46-0.78;P< 0.001) compared with patients <65 years of age. In patients ≥75 years of age, a risk reversal was observed whereby the risk for death without prior fast VTA exceeded the risk for developing fast VTA. A history of nonsustained ventricular tachycardia, male sex, and the presence of nonischemic cardiomyopathy were identified as predictors of fast VTA in patients ≥75 years of age.ConclusionsPatients ≥75 years of age have a significantly lower risk for VTA and ICD shocks compared with younger patients. Aging is associated with a higher risk for death compared with the risk for fast VTA, the reverse of what is seen in younger patients.