Effect of angiotensin-converting enzyme inhibitors and receptor blockers on appropriate implantable cardiac defibrillator shock in patients with severe systolic heart failure (from the GRADE Multicenter Study).
Effect of angiotensin-converting enzyme inhibitors and receptor blockers on appropriate implantable cardiac defibrillator shock in patients with severe systolic heart failure (from the GRADE Multicenter Study).
复制标题
DOI：
10.1016/j.amjcard.2015.01.020
复制
发表时间：
2015-04-01
影响因子：
2.8
通讯作者：
London, Barry
中科院分区：
文献类型：
--
作者：
AlJaroudi, Wael A.;Refaat, Marwan M.;Habib, Robert H.;Al-Shaar, Laila;Singh, Madhurmeet;Gutmann, Rebecca;Bloom, Heather L.;Dudley, Samuel C.;Ellinor, Patrick T.;Saba, Samir F.;Shalaby, Alaa A.;Weiss, Raul;McNamara, Dennis M.;Halder, Indrani;London, Barry
心源性猝死（SCD）是心肌病患者死亡的主要原因。虽然血管紧张素转换酶抑制剂（ACEi）和受体阻滞剂（ARB）降低了这些队列的心脏死亡率，但其在预防SCD中的作用尚未得到充分证实。我们试图确定心肌病患者使用ACEi或ARB是否与除颤器事件遗传风险评估（GRADE）研究中适当植入式心脏除颤器（ICD）电击的发生率较低相关，该研究包括射血分数≤30%和ICD的受试者。使用ACEi/ARB与不使用ACEi/ARB的治疗取决于医生。共有1509例患者（平均年龄[SD] 63[12]岁，80%为男性，平均[SD] EF 21% [6%]），其中1213例（80%）接受ACEi/ARB治疗，296例（20%）未接受ACEi/ARB治疗。我们确定了574名倾向匹配的患者（每组287名）。在平均（SD）2.5（1.9）年后，整个队列中有334例（22%）适当的电击。在匹配队列中，使用ACEi/ARB与1年、3年和5年时较低的休克发生率相关（7.7%、16.7%、18.5% vs. 13.2%、27.5%和32.0%（RR= 0.61[0.43-0.86]，p =0.005）。在GFR >60和30-60 ml/min/1.73 m2的患者中，与接受ACEi/ARB的患者相比，接受非ACEi/ARB的患者ICD休克的风险分别增加45%和77%。在GFR ≥30 ml/min/1.73m2的心肌病患者中，ACEi/ARB与适当ICD电击的发生率显著降低相关，在GFR <30 ml/min/1.73m2的患者中，ACEi/ARB具有中性效应。
Sudden cardiac death (SCD) is a leading cause of mortality in patients with cardiomyopathy. While angiotensin converting enzyme inhibitors (ACEi) and receptor blockers (ARB) decrease cardiac mortality in these cohorts, their role in preventing SCD has not been well established. We sought to determine whether the use of ACEi or ARB in patients with cardiomyopathy is associated with a lower incidence of appropriate implantable cardiac defibrillator (ICD) shocks in the Genetic Risk Assessment of Defibrillator Events (GRADE) study which included subjects with an ejection fraction of ≤30% and ICDs. Treatment with ACEi/ARB versus no ACEi/ARB was physician dependent. There were 1509 patients (mean age [SD] 63[12] years, 80% male, mean [SD] EF 21% [6%]) with 1213 (80%) on ACEi/ARB, and 296 (20%) not on ACEi/ARB. We identified 574 propensity matched patients (287 in each group). After a mean (SD) of 2.5(1.9) years, there were 334 (22%) appropriate shocks in the entire cohort. The use of ACEi/ARB was associated with lower incidence of shocks at 1, 3 and 5 years in the matched cohort (7.7%, 16.7%, 18.5% vs. 13.2%, 27.5%, and 32.0% (RR= 0.61[0.43–0.86], p =0.005). Among patients with GFR >60 and 30–60 ml/min/1.73m2, those on no-ACEi/ARB were at 45% and 77% increased risk of ICD shock as compared to those on ACEi/ARB, respectively. ACEi/ARB were associated with significant lower incidence of appropriate ICD shock in patients with cardiomyopathy and GFR ≥30 ml/min/1.73m2, and with neutral effect among those GFR <30 ml/min/1.73m2.
登录
查看更多内容
影响因子：
2.7
作者：
Massare J;Berry JM;Luo X;Rob F;Johnstone JL;Shelton JM;Bassel-Duby R;Hill JA;Naseem RH
通讯作者：
Naseem RH
影响因子：
2.8
作者：
KJEKSHUS, J;SWEDBERG, K;SNAPINN, S
通讯作者：
SNAPINN, S
影响因子：
3.5
作者：
Hage, Fadi G.;AlJaroudi, Wael;Iskandrian, Ami E.
通讯作者：
Iskandrian, Ami E.
影响因子：
158.5
作者：
PFEFFER, MA;BRAUNWALD, E;HAWKINS, CM
通讯作者：
HAWKINS, CM
影响因子：
5.5
作者：
Refaat MM;Lubitz SA;Makino S;Islam Z;Frangiskakis JM;Mehdi H;Gutmann R;Zhang ML;Bloom HL;MacRae CA;Dudley SC;Shalaby AA;Weiss R;McNamara DM;London B;Ellinor PT
通讯作者：
Ellinor PT