Racial differences in outcome in the Multicenter UnSustained Tachycardia Trial (MUSTT) - A comparison of whites versus blacks
Racial differences in outcome in the Multicenter UnSustained Tachycardia Trial (MUSTT) - A comparison of whites versus blacks
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DOI：
10.1161/01.cir.0000078640.59296.6f
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发表时间：
2003-07-08
期刊：
影响因子：
37.8
通讯作者：
Buxton, AE
中科院分区：
文献类型：
--
作者：
Russo, AM;Hafley, GE;Buxton, AE
多中心非持续性心动过速试验（MUSTT）证实了植入式心律转复器（ICD）对冠心病、无症状非持续性室性心动过速和左心室功能减退患者的益处。以前的研究表明，种族差异的风险，突然死亡的缺血性heartdisease.Methods和结果，我们分析了种族的影响，结果的MUSTT。与黑人相比，白人更可能有既往血运重建和可诱导的、可随机化的持续性室性心律失常，左心室肥大的可能性更小。与黑人相比，随机分配到电生理（EP）引导治疗的白人有较低的猝死/心脏骤停风险（校正P=0.003）和较低的总死亡率（校正P=0.051）。相比之下，随机分配至无电生理指导治疗组的患者中，猝死/心脏骤停的风险无种族差异（校正P=0.477）。在白人中，与无电生理指导治疗相比，电生理指导治疗的生存率更高。然而，随机分配到没有EP引导治疗的黑人的生存率优于接受EP引导治疗的黑人。这种差异的部分原因是白人的ICD植入率高于黑人（50%比28%，P=0.034）。白人更有可能保持诱导后，系列EP引导的药物测试（67%对42%，P=0.011），使他们更有可能成为合格的ICDs. Conclusions，在这项试验的结果和EP引导治疗的好处似乎是受种族。除了ICD植入率的差异外，抗心律失常药物的抗心律失常底物和促心律失常反应的差异也可能影响结局。
Background-The Multicenter UnSustained Tachycardia Trial (MUSTT) demonstrated the benefit of implantable cardioverter-defibrillators (ICDs) in patients with coronary disease, asymptomatic nonsustained ventricular tachycardia, and reduced left ventricular function. Previous studies have shown racial differences in risk of sudden death in patients with ischemic heart disease.Methods and Results-We analyzed the influence of race on results of MUSTT. Whites were more likely to have prior revascularization and inducible, randomizable sustained ventricular arrhythmias and less likely to have left ventricular hypertrophy than were blacks. Compared with blacks, whites randomly assigned to electrophysiologically (EP)-guided therapy had a lower risk of arrhythmic death/cardiac arrest (adjusted P=0.003) and lower total mortality rates (adjusted P=0.051). In contrast, there was no racial difference in the risk of arrhythmic death/cardiac arrest among patients randomly assigned to no EP-guided therapy (adjusted P=0.477). Among whites, EP-guided therapy resulted in a survival benefit compared with no EP-guided therapy. However, survival of blacks randomly assigned to no EP-guided therapy was better than blacks receiving EP-guided therapy. This difference is partially explained by a higher ICD implantation rate in whites versus blacks (50% versus 28%, P=0.034). Whites were more likely to remain inducible after serial EP-guided drug testing (67% versus 42%, P=0.011), making them more likely to become eligible for ICDs.Conclusions-The outcome in this trial and the benefit of EP-guided therapy appeared to be influenced by race. In addition to differences in ICD implantation rates, differences in arrhythmic substrates and proarrhythmic responses to antiarrhythmic drugs may have influenced outcome.