Shocks burden and increased mortality in implantable cardioverter-defibrillator patients
Shocks burden and increased mortality in implantable cardioverter-defibrillator patients
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DOI：
10.1016/j.hrthm.2011.07.036
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发表时间：
2011-12-01
期刊：
影响因子：
5.5
通讯作者：
Raitt, Merritt H.
中科院分区：
文献类型：
--
作者：
Larsen, Gail K.;Evans, John;Raitt, Merritt H.
背景植入性心律转复除颤器(ICD)电击与死亡风险增加相关。目前尚不清楚ICD电击本身是有害的，还是高危患者的标志。目的我们旨在根据西雅图心力衰竭模型(SHFM)校正基线死亡率后，评估ICD电击与死亡时间之间的关系。方法初步分析比较了未接受电击的患者和接受任何类型电击的患者的死亡时间，这些患者在植入时根据SHFM评分进行了调整和其他并发症的调整。亚组分析进一步描述休克与死亡风险之间的关系。结果平均随访41个月(四分位数范围23-)，59%的患者发生一次或多次休克，40%的患者死亡。接受任何类型电击的患者与不接受电击的患者相比，死亡风险增加(风险比1.55；95%可信区间1.07-2.23；P=0.02)。休克天数为1-5天的患者死亡风险无明显增加(1.30[0.88-0.94]；P=0.19)，休克天数为6-10天的患者死亡风险增加(2.22[1.21-4.08]天；休克天数为3.66[1.86-7.19]；P
BACKGROUND Implantable cardioverter-defibrillator (ICD) shocks are associated with an increased risk of death. It is unclear whether ICD shocks are detrimental per se or a marker of higher risk patients.OBJECTIVE We aimed to assess the association between ICD shocks and time to death after correction for baseline mortality based on the Seattle Heart Failure Model (SHFM).METHODS The primary analysis compared time-to-death between patients receiving no shocks and patients receiving shocks of any type adjusted for SHFM score at time of implantation and other comorbidities. Subgroup analyses were performed to further describe the relationship between shocks and mortality risk.RESULTS Over a median follow-up of 41 months (interquartile range 23-64), one or more shock episodes occurred in 59% of 425 patients and 40% of the patients died. Patients receiving shocks of any type had increased risk of death (hazard ratio 1.55; 95% confidence interval 1.07-2.23; P = .02) versus patients receiving no shocks. While patients with 1-5 days with shock (shock days) did not show evidence of increased risk of death (1.30 [0.88-.94]; P = 0.19), those with 6-10 shock days (2.22 [1.21-4.08]; P 10 shock days (3.66 [1.86 -7.19]; P