INFLUENCE OF IMPLANTABLE CARDIOVERTER-DEFIBRILLATORS ON THE LONG-TERM PROGNOSIS OF SURVIVORS OF OUT-OF-HOSPITAL CARDIAC-ARREST
INFLUENCE OF IMPLANTABLE CARDIOVERTER-DEFIBRILLATORS ON THE LONG-TERM PROGNOSIS OF SURVIVORS OF OUT-OF-HOSPITAL CARDIAC-ARREST
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DOI：
10.1161/01.cir.88.3.1083
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发表时间：
1993-09-01
期刊：
影响因子：
37.8
通讯作者：
RUSKIN, JN
中科院分区：
文献类型：
--
作者：
POWELL, AC;FUCHS, T;RUSKIN, JN
背景与急性心肌梗死无关的院外心脏骤停的幸存者发生心脏骤停和心源性猝死的风险很高。植入式心律转复除颤器对这些患者长期预后的影响尚不确定。331例院外心脏骤停的幸存者（年龄56 ± 13.7岁）接受了电生理引导治疗。150例患者（45.3%）植入了植入式人工心脏，181例患者（54.7%）仅接受药物和/或手术治疗。接受除颤器的患者左心室射血分数为35.2 ± 16.6%，未接受除颤器的患者为45.3 ± 18.2%。除颤器组患者的中位随访时间为24个月，非除颤器组为46个月。在比例风险模型中，总心脏死亡率的独立预测因子是左心室射血分数小于0.40（相对风险，4.55; 95%置信区间，2.44 - 8.33; P=.0001），无植入式除颤器（相对危险度，2.70;可信区间，1.41 ~ 5.00; P= 0.017）和可诱导持续性室性心动过速的持续性（相对危险度，1.84; 95%可信区间，0.97 ~ 3.49; P= 0.045）。左心室射血分数小于0.40的患者，使用除颤器的1年和5年无心源性死亡的生存概率分别为94.3%和69.6%，未使用除颤器的分别为82.1%和45.3%。对于左心室射血分数≥ 0.40的患者，使用除颤器的1年和5年无心源性死亡的生存概率分别为97.7%和94.6%，未使用除颤器的分别为95.4%和86.9%。在院外心脏骤停的幸存者中，植入式除颤器与心源性死亡率的降低相关，特别是在左心室功能受损的患者中。
Background. Survivors of out-of-hospital cardiac arrest not associated with acute myocardial infarction are at high risk for recurrent cardiac arrest and sudden cardiac death. The impact of the implantable cardioverter-defibrillator on long-term prognosis in these patients is uncertain.Methods and Results. Three hundred thirty-one survivors of out-of-hospital cardiac arrest (age, 56+/-13.7 years) underwent electrophysiologically guided therapy. Implantable defibrillators were placed in 150 patients (45.3%), and 181 patients (54.7%) received pharmacological and/or surgical therapy alone. Left ventricular ejection fraction was 35.2+/-16.6% in defibrillator recipients and 45.3+/-18.2% in nondefibrillator patients. Median patient follow-up was 24 months in the defibrillator group and 46 months in the nondefibrillator group. In a proportional hazards model, the independent predictors of total cardiac mortality were left ventricular ejection fraction of less than 0.40 (relative risk, 4.55; 95% confidence interval, 2.44 to 8.33; P=.0001), absence of an implantable defibrillator (relative risk, 2.70; confidence interval, 1.41 to 5.00; P=.017), and persistence of inducible sustained ventricular tachycardia (relative risk, 1.84; 95% confidence interval, 0.97 to 3.49; P=.045). The 1- and 5-year probabilities of survival free of cardiac mortality in patients with left ventricular ejection fraction of less than 0.40 were 94.3% and 69.6% with a defibrillator and 82.1% and 45.3% without a defibrillator, respectively. For patients with left ventricular ejection fraction of 0.40 or more, the 1- and 5-year probabilities of survival free of cardiac mortality were 97.7% and 94.6% with a defibrillator and 95.4% and 86.9% without a defibrillator, respectively.Conclusions. In survivors of out-of-hospital cardiac arrest, the implantable defibrillator is associated with a reduction in cardiac mortality, particularly in patients with impaired left ventricular function.