Arrhythmic and Mortality Outcomes Among Ischemic Versus Nonischemic Cardiomyopathy Patients Receiving Primary ICD Therapy.
Arrhythmic and Mortality Outcomes Among Ischemic Versus Nonischemic Cardiomyopathy Patients Receiving Primary ICD Therapy.
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DOI：
10.1016/j.jacep.2021.06.020
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发表时间：
2022-01
期刊：
影响因子：
--
通讯作者：
Goldenberg I
中科院分区：
文献类型：
--
作者：
Narins CR;Aktas MK;Chen AY;McNitt S;Ling FS;Younis A;Zareba W;Daubert JP;Huang DT;Rosero S;Kutyifa V;Goldenberg I
关于缺血性与非缺血性心肌病（ICM/NICM）患者一级预防植入式心律转复除颤器（ICD）治疗的获益，存在相互矛盾的数据。我们试图确定心肌病病因与室性心律失常的可能性、适当的ICD治疗和死亡率之间的关系。研究人群包括1997年至2017年期间进行的5项随机试验中入组的4，803例ICM（n= 3，106）或NICM（n= 1，697）患者，这些患者均植入了一级预防ICD。主要终点为持续性室性心动过速≥200 bpm或室颤（VT/VF）。次要终点包括适当的ICD治疗和全因死亡率。还检查了原因特异性死亡率的差异，包括非心源性、突发心源性和非突发心源性。ICM患者年龄明显较大，合并症较多，而NICM患者在入组时心力衰竭（HF）分级更高，更常接受药物或心脏硬化治疗。多变量分析显示ICM与NICM的VT/VF事件风险相似（HR=0.98 [95% CI 0.79-1.20]）和适当的ICD治疗（HR=1.03 [95% CI 0.87-1.22]），而ICM患者的全因死亡风险是NICM患者的1.8倍（HR=1.84 [95%CI 1.42-2.38]），主要为非突发心源性死亡。来自5项具有里程碑意义的ICD临床试验的综合数据显示，与NICM患者相比，ICM患者发生危及生命的室性心律失常事件的风险相似，但全因死亡的风险增加，主要是非心源性猝死。我们研究了一级预防植入式心律转复除颤器（ICD）治疗的结局和潜在获益在缺血性与非缺血性心肌病（ICM/NICM）患者中是否存在差异。在入组5项前瞻性临床试验的4，803例植入一级预防ICD的患者中，ICM与NICM的持续快速室性心动过速或室颤和适当除颤器治疗的风险相似。缺血性心肌病的死亡率（主要与非心源性猝死相关）显著较高。我们的结论是，与ICM患者相比，NICM患者表现出相似的免疫负担，但死亡率较低。
There are conflicting data on the benefit of primary prevention implantable cardioverter-defibrillator (ICD) therapy in patients with ischemic versus non-ischemic cardiomyopathy (ICM/NICM). We sought to determine the association of cardiomyopathy etiology with the likelihood of ventricular arrhythmias, appropriate ICD therapy and mortality. The study population comprised 4,803 patients with ICM (n=3,106) or NICM (n=1,697) with a primary prevention ICD enrolled in 5 randomized trials conducted between 1997 and 2017. The primary endpoint was sustained ventricular tachycardia ≥200 bpm or ventricular fibrillation (VT/VF). Secondary endpoints included appropriate ICD therapy and all-cause mortality. Differences in cause-specific mortality, including non-cardiac, sudden cardiac, and non-sudden cardiac, were also examined. Patients with ICM were significantly older and had more comorbid conditions, whereas those with NICM had more advanced heart failure (HF) class at enrollment and were more often prescribed medical or cardiac resynchronization therapy for HF. Multivariate analysis showed that ICM vs. NICM had a similar risk of VT/VF events (HR=0.98 [95% CI 0.79–1.20]) and appropriate ICD therapy (HR=1.03 [95% CI 0.87–1.22]), whereas the risk of all-cause mortality was 1.8-fold higher among ICM vs. NICM patients (HR=1.84 [95%CI 1.42–2.38]), dominated by non-sudden cardiac mortality. Combined data from 5 landmark ICD clinical trials show that ICM patients experience a similar risk of life-threatening ventricular arrhythmic events but have an increased risk of all-cause mortality, dominated by non-sudden cardiac death, compared with NICM patients. We examined whether outcomes and potential benefits of primary prevention implantable cardioverter-defibrillator (ICD) therapy differ among individuals with ischemic versus non-ischemic cardiomyopathy (ICM/NICM). Among 4,803 patients with a primary prevention ICD enrolled in five prospective clinical trials, the risks of sustained rapid ventricular tachycardia or fibrillation and appropriate defibrillator therapy were similar in ICM versus NICM. Mortality, primarily related to non-sudden cardiac death, was substantially higher with ischemic cardiomyopathy. We conclude that individuals with NICM demonstrate similar arrhythmic burden but a lower incidence of death compared to those with ICM.
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影响因子：
158.5
作者：
Moss, AJ;Hall, WJ;Heo, M
通讯作者：
Heo, M
影响因子：
158.5
作者：
Moss, Arthur J.;Hall, W. Jackson;Zareba, Wojciech
通讯作者：
Zareba, Wojciech
DOI：
10.1016/j.jacep.2016.09.006
发表时间：
2017-03-01
期刊：
JACC. Clinical electrophysiology
影响因子：
--
作者：
Levy, Wayne C;Li, Yanhong;O'Connor, Christopher M
通讯作者：
O'Connor, Christopher M
影响因子：
158.5
作者：
Buxton, AE;Lee, KL;Hafley, G
通讯作者：
Hafley, G
影响因子：
39.3
作者：
Priori, Silvia G.;Blomstrom-Lundqvist, Carina;Zannad, Faiez
通讯作者：
Zannad, Faiez