Impact of the timing of first appropriate shock on outcomes in patients with an implantable cardioverter-defibrillator: Early versus late.
Impact of the timing of first appropriate shock on outcomes in patients with an implantable cardioverter-defibrillator: Early versus late.
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首次适当电击时间对植入式心律转复除颤器患者预后的影响：早期与晚期。
DOI：
10.1111/pace.14627
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发表时间：
2023
期刊：
影响因子：
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通讯作者：
Nobuhisa Hagiwara.
中科院分区：
文献类型：
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作者：
Makoto Kishihara;Hidetoshi Hattori;Atsushi Suzuki;Miwa Kanai;Shohei Kataoka;Kyoichiro Yazaki;Noriko Kikuchi;Daigo Yagishita;Yuichiro Minami;Junichi Yamaguchi;Morio Shoda;Nobuhisa Hagiwara.
背景适当的植入式心律转复除颤器（ICD）电击与死亡率和心力衰竭（HF）事件的风险增加相关。第一次适当的电击可能发生在植入后较晚的时候。然而，第一次适当电击的时机是否影响预后尚不清楚。本研究旨在评估ICD患者首次适当电击时机的临床意义。MethodsThis回顾性和观察性研究纳入了565例连续ICD患者。将接受合适电击的患者分为早期组（ICD植入后1年内首次合适电击）和晚期组（ICD植入后≥1年首次合适电击）。两组之间的全因死亡率进行了比较。结果在中位随访时间为5.6年，112例（19.8%）患者接受了适当的休克，其中32例（28.6%）在早期组和80例（71.4%）在晚期组。ICD植入时基线特征的比较显示，晚期组更有可能接受心脏起搏治疗（66.3% vs. 31.3%，p < 0.001），ICD用于一级预防（60. 0% vs. 31.3%，p = 0.001），血管紧张素转换酶抑制剂或血管紧张素受体阻滞剂治疗（88.8% vs. 71.9%，p = 0.028）。休克后的生存率在晚期组比早期组显著更差（p= 0.027）。在多变量考克斯比例风险分析中，晚期组的全因死亡风险高于早期组（HR：2.22; 95% CI 1.01-4.53; p= 0.029）。在这两组中，最常见的死亡原因是HF.ConclusionsLate发生的第一个适当的ICD休克与预后较差的第一个适当的休克早期发生相比。心源性死亡是晚期发生首次适当ICD电击的患者的最常见死亡原因，大多数情况下由HF引起。
BackgroundAppropriate implantable cardioverter‐defibrillator (ICD) shocks are associated with an increased risk of mortality and heart failure (HF) events. The first appropriate shock may occur late after implantation. However, whether the timing of the first appropriate shock influences prognosis is unknown. This study aimed to evaluate the clinical significance of the timing of the first appropriate shock in patients with ICD.MethodsThis retrospective and observational study enrolled 565 consecutive ICD patients. Patients who received an appropriate shock were divided into the early group (first appropriate shock <1 year after ICD implantation) and late group (first appropriate shock ≥1 year after ICD implantation). All‐cause mortality was compared between the two groups.ResultsOver a median follow‐up of 5.6 years, 112 (19.8%) patients received an appropriate shock, including 32 patients (28.6%) in the early group and 80 patients (71.4%) in the late group. Comparisons of baseline characteristics at ICD implantation revealed that the late group was more likely to receive cardiac resynchronization therapy (66.3% vs. 31.3%,p< 0.001), ICD for primary prevention (60.0% vs. 31.3%,p= 0.001), and angiotensin‐converting enzyme inhibitor or angiotensin‐receptor blocker treatment (88.8% vs. 71.9%,p= 0.028). Survival after shock was significantly worse in the late group than in the early group (p= 0.027). In multivariable Cox proportional hazards analysis, the late group had an increased risk of all‐cause mortality compared with the early group (HR: 2.22; 95% CI 1.01–4.53; p= 0.029). In both groups, the most common cause of death was HF.ConclusionsLate occurrence of the first appropriate ICD shock was associated with a worse prognosis compared with early occurrence of the first appropriate shock. Cardiac death was the most common cause of death in patients who experienced late occurrence of the first appropriate ICD shock, resulting from HF in most cases.