Prognostic importance of defibrillator shocks in patients with heart failure.
Prognostic importance of defibrillator shocks in patients with heart failure.
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DOI：
10.1056/nejmoa071098
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发表时间：
2008-09-04
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影响因子：
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通讯作者：
Bardy GH
中科院分区：
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作者：
Poole JE;Johnson GW;Hellkamp AS;Anderson J;Callans DJ;Raitt MH;Reddy RK;Marchlinski FE;Yee R;Guarnieri T;Talajic M;Wilber DJ;Fishbein DP;Packer DL;Mark DB;Lee KL;Bardy GH
接受植入式心脏复律除颤器 (ICD) 进行一级预防（即预防首次危及生命的心律失常事件）的心力衰竭患者随后可能会接受 ICD 的治疗性电击。有关此类患者 ICD 治疗后长期预后的信息有限。在 829 名被随机分配接受 ICD 治疗的心力衰竭患者中，我们在 811 名患者中植入了 ICD。室性心动过速或心室颤动发作后进行 ICD 电击被认为是合适的。所有其他 ICD 电击均被认为是不合适的。在中位随访时间 45.5 个月中，269 名患者 (33.2%) 接受了至少一次 ICD 电击，其中 128 名患者仅接受适当的电击，87 名患者仅接受不适当的电击，54 名患者接受两种类型的电击。在根据基线预后因素进行调整的 Cox 比例风险模型中，与无适当电击相比，适当的 ICD 电击与随后全因死亡风险显着增加相关（风险比，5.68；95% 置信区间 [CI]，3.97 至 8.12；P<0.001）。与没有不适当电击相比，不适当的 ICD 电击也与死亡风险显着增加相关（风险比，1.98；95% CI，1.29 至 3.05；P = 0.002）。对于在适当的 ICD 电击后存活超过 24 小时的患者，死亡风险仍然较高（风险比，2.99；95% CI，2.04 至 4.37；P<0.001）。接受 ICD 电击的患者最常见的死亡原因是进行性心力衰竭。在因一级预防而植入 ICD 的心力衰竭患者中，因心律失常而接受电击的患者的死亡风险明显高于未接受此类电击的类似患者。
Patients with heart failure who receive an implantable cardioverter–defibrillator (ICD) for primary prevention (i.e., prevention of a first life-threatening arrhythmic event) may later receive therapeutic shocks from the ICD. Information about long-term prognosis after ICD therapy in such patients is limited. Of 829 patients with heart failure who were randomly assigned to ICD therapy, we implanted the ICD in 811. ICD shocks that followed the onset of ventricular tachycardia or ventricular fibrillation were considered to be appropriate. All other ICD shocks were considered to be inappropriate. Over a median follow-up period of 45.5 months, 269 patients (33.2%) received at least one ICD shock, with 128 patients receiving only appropriate shocks, 87 receiving only inappropriate shocks, and 54 receiving both types of shock. In a Cox proportional-hazards model adjusted for baseline prognostic factors, an appropriate ICD shock, as compared with no appropriate shock, was associated with a significant increase in the subsequent risk of death from all causes (hazard ratio, 5.68; 95% confidence interval [CI], 3.97 to 8.12; P<0.001). An inappropriate ICD shock, as compared with no inappropriate shock, was also associated with a significant increase in the risk of death (hazard ratio, 1.98; 95% CI, 1.29 to 3.05; P = 0.002). For patients who survived longer than 24 hours after an appropriate ICD shock, the risk of death remained elevated (hazard ratio, 2.99; 95% CI, 2.04 to 4.37; P<0.001). The most common cause of death among patients who received any ICD shock was progressive heart failure. Among patients with heart failure in whom an ICD is implanted for primary prevention, those who receive shocks for any arrhythmia have a substantially higher risk of death than similar patients who do not receive such shocks.