Randomized antiarrhythmic drug therapy in survivors of cardiac arrest (the CASCADE Study). The CASCADE Investigators.
Randomized antiarrhythmic drug therapy in survivors of cardiac arrest (the CASCADE Study). The CASCADE Investigators.
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心脏骤停幸存者的随机抗心律失常药物治疗（CASCADE 研究）。
DOI：
10.1016/0002-9149(93)90673-z
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发表时间：
1993
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西雅图的心脏骤停：传统与胺碘酮药物评价（CASCADE）研究评价了与Q波心肌梗死无关的院外室颤（VF）幸存者的抗心律失常药物治疗，这些患者的VF复发风险特别高。根据电生理测试、霍尔特记录或两者（常规治疗）指导，将治疗随机分配至胺碘酮经验性治疗与其他抗心律失常药物治疗。本研究的主要终点为心源性死亡率、因记录的VF而复苏的心脏骤停或完全晕厥，随后植入自动除颤器导致的电击，共有228例患者入组本研究，胺碘酮治疗组和常规治疗组的基线特征相似。202例患者（89%）为男性，平均年龄62岁。冠状动脉疾病是最常见的基础疾病（188/228，82%），在冠状动脉患者中，153/188（81%）在索引VF事件之前经历过既往心肌梗死。平均左心室射血分数为0.35，102例患者（45%）既往有充血性心力衰竭病史，2年时无心源性死亡、室颤复苏或晕厥除颤器休克的生存率为75（胺碘酮，82%;常规，69%），4年时为59%（胺碘酮，66%;常规，52%），6年时为46%（胺碘酮，53%;常规，40%）; p = 0.007。无心源性死亡和持续性室性心律失常的生存率在2年时为65%（胺碘酮，78%;常规，52%），4年时为43%（胺碘酮，52%;常规，36%），6年时为30%（胺碘酮，41%;常规，20%）; p < 0.001。
The Cardiac Arrest in Seattle: Conventional Versus Amiodarone Drug Evaluation (CASCADE) study evaluated antiarrhythmic drug treatment of survivors of out-of-hospital ventricular fibrillation (VF) not associated with a Q-wave myocardial infarction who were at especially high risk of recurrence of VF. Therapy was randomized to empiric treatment with amiodarone versus treatment with other antiarrhythmic drugs guided by electrophysiotogic testing, Holter recording, or both (conventional therapy). The primary end points of the study were cardiac mortality, resuscitated cardiac arrest due to documented VF, or complete syncope followed by a shock from an implanted automatic defibrillator.Two hundred twenty-eight patients were enrolled in the study, and baseline characteristics were similar in the patients treated with amiodarone and with conventional therapy. Two hundred two patients (89%) were men with an average age of 62 years. Coronary artery disease was the most common underlying condition (188 of 228, 82%), and in coronary patients, 153 of 188 (81%) had experienced a prior myocardial infarction before the index VF event. Mean left ventricular ejection fraction was 0.35, and 102 patients (45%) had a prior history of congestive heart failure.Survival free of cardiac death, resuscitated VF, or syncopal defibrillator shock for the entire population was 75% at 2 years (amiodarone, 82%; conventional, 69%), 59% at 4 years (amiodarone, 66%; conventional, 52%), and 46% at 6 years (amiodarone, 53%; conventional, 40%); p = 0.007. The survival free of cardiac death and sustained ventricular arrhythmias was 65% at 2 years (amiodarone, 78%; conventional, 52%), 43% at 4 years (amiodarone, 52%; conventional, 36%), and 30% at 6 years (amiodarone, 41%; conventional, 20%); p < 0.001.