Cause of Death in Patients With Acute Heart Failure Insights From RELAX-AHF-2
Cause of Death in Patients With Acute Heart Failure Insights From RELAX-AHF-2
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DOI：
10.1016/j.jchf.2020.09.010
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发表时间：
2020-12-01
影响因子：
13
通讯作者：
Felker, G. Michael
中科院分区：
文献类型：
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作者：
Loungani, Rahul S.;Teerlink, John R.;Felker, G. Michael
目的：本研究旨在通过分析RELAX - AHF - 2试验（急性心力衰竭2中在标准治疗基础上加用塞来昔布的有效性、安全性和耐受性试验）中患者的死亡原因，更好地理解2项塞来昔布治疗急性心力衰竭（AHF）以及AHF后短期死亡率的试验中存在差异的结果。
背景：急性心力衰竭患者的短期死亡率仍然很高，但对该患者群体死亡原因的系统性分析有限。
方法：对RELAX - AHF - 2试验中患者判定的死亡原因进行了分析，该试验是一项针对不同射血分数（EF）的急性心力衰竭患者进行的塞来昔布随机、双盲、安慰剂对照试验。
结果：在随访180天内，RELAX - AHF - 2试验中11.5%的患者死亡，主要死于心力衰竭（HF）（占所有死亡的38%）。与RELAX - AHF试验不同，塞来昔布治疗对任何类别死亡原因均无明显影响。老年患者（≥75岁）与年轻患者相比，死亡率（14.2%对8.8%）和非心血管（CV）死亡发生率（27%对19%）更高。射血分数保留（≥50%）的患者与射血分数降低的患者相比，心力衰竭相关死亡率较低（30%对40%），但非心血管死亡率较高（36%对20%）。
结论：尽管先前的数据表明塞来昔布对急性心力衰竭有益，但在RELAX - AHF - 2试验中，未发现塞来昔布治疗可改善总体死亡率或对任何类别死亡原因产生影响。对塞来昔布试验中事件的仔细判定表明，老年患者和射血分数保留的患者死于心力衰竭或猝死的较少，而死于其他心血管原因和非心脏原因的较多。（急性心力衰竭中在标准治疗基础上加用塞来昔布的有效性、安全性和耐受性[RELAX - AHF - 2]；© 2020美国心脏病学会基金会）
OBJECTIVES This study sought to better understand the discrepant results of 2 trials of serelaxin on acute heart failure (AHF) and short-term mortality after AHF by analyzing causes of death of patients in the RELAX-AHF-2 (Efficacy, Safety and Tolerability of Serelaxin When Added to Standard Therapy in AHF-2) trial.BACKGROUND Patients with AHF continue to suffer significant short-term mortality, but limited systematic analyses of causes of death in this patient population are available.METHODS Adjudicated cause of death of patients in RELAX-AHF-2, a randomized, double-blind, placebo-controlled trial of serelaxin in patients with AHF across the spectrum of ejection fraction (EF), was analyzed.RESULTS By 180 days of follow-up, 11.5% of patients in RELAX-AHF-2 died, primarily due to heart failure (HF) (38% of all deaths). Unlike RELAX-AHF, there was no apparent effect of treatment with serelaxin on any category of cause of death. Older patients ($75 years) had higher rates of mortality (14.2% vs. 8.8%) and noncardiovascular (CV) death (27% vs. 19%) compared to younger patients. Patients with preserved EF ($50%) had lower rates of HF-related mortality (30% vs. 40%) but higher non-CV mortality (36% vs. 20%) compared to patients with reduced EF.CONCLUSIONS Despite previous data suggesting benefit of serelaxin in AHF, treatment with serelaxin was not found to improve overall mortality or have an effect on any category of cause of death in RELAX-AHF-2. Careful adjudication of events in the serelaxin trials showed that older patients and those with preserved EF had fewer deaths from HF or sudden death and more deaths from other CV causes and from noncardiac causes. (Efficacy, Safety and Tolerability of Serelaxin When Added to Standard Therapy in AHF [RELAX-AHF-2]; (C) 2020 by the American College of Cardiology Foundation.