Does the Implantable Cardioverter-Defibrillator Benefit Vary With the Estimated Proportional Risk of Sudden Death in Heart Failure Patients?
Does the Implantable Cardioverter-Defibrillator Benefit Vary With the Estimated Proportional Risk of Sudden Death in Heart Failure Patients?
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DOI：
10.1016/j.jacep.2016.09.006
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发表时间：
2017-03-01
期刊：
影响因子：
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通讯作者：
O'Connor, Christopher M
中科院分区：
文献类型：
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作者：
Levy, Wayne C;Li, Yanhong;O'Connor, Christopher M
背景技术背景：预测哪些心力衰竭患者最有可能死于猝死与非猝死是决定谁将受益最多的一个重要因素从ICD.OBJECTIVE：我们开发了西雅图比例风险模型（SPRM），以估计由于猝死的总死亡率的比例。我们前瞻性地验证了模型的HF-行动和测试是否ICD的好处与SPRM.METHODS不同：在2331例患者入组，1947例患者被保留的分析超过了中位随访2.5年。SPRM的计算使用年龄，性别，糖尿病，BMI，SBP，EF，NYHA，钠，肌酐，和地高辛use.RESULTS：ICD的使用（ICD或CRT-D）之前死亡的1204例（62%）。SPRM可预测无ICD患者的猝死与非猝死（P=0.002）。ICD与无ICD的全因死亡率风险比为0.63（P=0.0002）。ICD的获益因SPRM的全因死亡率而异（P=0.001），在猝死条件概率较高的患者中获益更大。结论：在非卧床NYHA II-IV级HF人群中，EF ≤ 35%，SPRM可预测猝死与非猝死的比例风险。ICD与全因死亡风险降低37%相关，ICD受益因SPRM而异。SPRM可用于对患者进行一级预防ICD的风险分层。
BACKGROUND: Prediction of which heart failure patients are most likely to die of sudden death vs. non-sudden death is an important factor in determining who will benefit the most from an ICD.OBJECTIVE: We developed the Seattle Proportional Risk Model (SPRM) to estimate the proportion of total mortality due to sudden death. We prospectively validated the model in HF-ACTION and tested whether the ICD benefit varied with the SPRM.METHODS: Among 2331 patients enrolled, 1947 patients were retained for analysis over a median follow-up of 2.5 years. The SPRM was calculated using age, gender, diabetes, BMI, SBP, EF, NYHA, sodium, creatinine, and digoxin use.RESULTS: ICD use (ICD or CRT-D) was present prior to death in 1204 patients (62%). SPRM was predictive of sudden death vs. non-sudden death in those without an ICD (P=0.002). The hazard ratio representing ICD versus no ICD was 0.63 for all-cause mortality (P=0.0002). The ICD benefit varied with the SPRM for all-cause mortality (P=0.001), with a greater benefit in those with a higher conditional probability of sudden death.CONCLUSIONS: In an ambulatory NYHA II-IV HF population and EF ≤35%, the SPRM was predictive of the proportional risk of sudden vs. non-sudden death. ICDs were associated with a decreased risk of all-cause mortality by 37% and the ICD benefit varied with the SPRM. The SPRM may have utility in risk stratifying patients for a primary prevention ICD.