Do baseline characteristics accurately discriminate between patients likely versus unlikely to benefit from implantable defibrillator therapy? Evaluation of the Canadian implantable defibrillator study implantable cardioverter defibrillatory efficacy scor
Do baseline characteristics accurately discriminate between patients likely versus unlikely to benefit from implantable defibrillator therapy? Evaluation of the Canadian implantable defibrillator study implantable cardioverter defibrillatory efficacy scor
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基线特征能否准确地区分可能或不可能从植入式除颤器治疗中受益的患者？
DOI：
10.1067/mhj.2001.111768
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发表时间：
2001
影响因子：
4.8
通讯作者：
Hallstrom,A
中科院分区：
文献类型：
--
作者：
Exner,DV;Sheldon,RS;Pinski,SL;Kron,J;Hallstrom,A
目的评价加拿大植入式除颤器研究（CIDS）中预测植入式心律转复除颤器（ICD）疗效的基线特征是否可预测抗心律失常药与植入式除颤器（AVID）试验。背景：在危及生命的心律失常患者中，ICD治疗上级优于抗心律失常药物。然而，识别最有可能从ICD治疗中获益的亚组可能是有用的。来自CIDS的数据表明，3个特征（年龄≥70岁，射血分数[EF] ≤0.35，纽约心脏协会分级>II级）可以结合起来，将患者可靠地分类为可能（≥2个特征）与不太可能（<2个特征）从ICD治疗中获益。方法采用Kaplan-Meier分析和考克斯风险模型对ICD疗效的CIDS分类进行评估。通过评价考克斯模型中获益分类与治疗之间的相互作用，正式检验了CIDS评分的准确性。结果：在320例可能受益的患者中，ICD治疗与死亡风险显著降低相关。（相对风险[RR] 0.57，95%置信区间[CI] 0.37-0.88，P = 0.01），689例归类为不太可能受益的患者的死亡风险有降低的趋势（RR 0.70，95% CI 0.48-1.03，P = .07）。获益分类不完善，缺乏统计学交互作用（P = .5）。虽然在AVID中通过ICD治疗预防的42例死亡中有32例属于可能获益的患者，但所有42例患者的EF值均≤0.35。高龄和较差的功能分级均不能预测AVID患者的ICD疗效。结论在预测ICD在CIDS中疗效的3个特征中，只有EF降低可预测ICD在AVID中的疗效。因此，对于EF值严重降低的患者，面临资源有限的医生可能会选择考虑ICD治疗而不是抗心律失常药物的使用。(Am Heart J 2001;141：99-104.）
Objective Our purpose was to evaluate whether baseline characteristics predictive of implantable cardioverter defibrillator (ICD) efficacy in the Canadian Implantable Defibrillator Study (CIDS) are predictive in the Antiarrhythmics Versus Implantable Defibrillators (AVID) Trial. Background ICD therapy is superior to antiarrhythmic drug use in patients with life-threatening arrhythmias. However, identification of subgroups most likely to benefit from ICD therapy may be useful. Data from CIDS suggest that 3 characteristics (age ≥70 years, ejection fraction [EF] ≤0.35, and New York Heart Association class >II) can be combined to reliably categorize patients as likely (≥2 characteristics) versus unlikely to benefit (<2 characteristics) from ICD therapy. Methods The utility of the CIDS categorization of ICD efficacy was assessed by Kaplan-Meier analysis and Cox hazards modeling. The accuracy of the CIDS score was formally tested by evaluating for interaction between categorization of benefit and treatment in a Cox model. Results ICD therapy was associated with a significantly lower risk of death in the 320 patients categorized as likely to benefit (relative risk [RR] 0.57, 95% confidence interval [CI] 0.37-0.88, P = .01) and a trend toward a lower risk of death in the 689 patients categorized as unlikely to benefit (RR 0.70, 95% CI 0.48-1.03, P = .07). Categorization of benefit was imperfect, as evidenced by a lack of statistical interaction (P = .5). Although 32 of the 42 deaths prevented by ICD therapy in AVID were in patients categorized as likely to benefit, all 42 of these patients had EF values ≤0.35. Neither advanced age nor poorer functional class predicted ICD efficacy in AVID. Conclusion Of the 3 characteristics identified to predict ICD efficacy in CIDS, only depressed EF predicted ICD efficacy in AVID. Thus physicians faced with limited resources might elect to consider ICD therapy over antiarrhythmic drug use in patients with severely depressed EF values. (Am Heart J 2001;141:99-104.)