Improved survival with an implanted defibrillator in patients with coronary disease at high risk for ventricular arrhythmia
Improved survival with an implanted defibrillator in patients with coronary disease at high risk for ventricular arrhythmia
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DOI：
10.1056/nejm199612263352601
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发表时间：
1996-12-26
影响因子：
158.5
通讯作者：
Heo, M
中科院分区：
文献类型：
--
作者：
Moss, AJ;Hall, WJ;Heo, M
背景：既往心肌梗死和左心室功能障碍患者的非持续性室性心动过速与约30%的两年死亡率相关。我们的研究。与常规药物治疗相比，植入心律转复除颤器的预防性治疗是否能提高这一高危人群的生存率。方法：在5年的时间里，196例纽约心脏协会功能分级为I、II或III级的既往心肌梗死患者；左心室射血分数小于等于0.35；无症状非持续性室性心动过速的记录发作；在电生理研究中，诱导性、非抑制性室性心动过速被随机分配接受植入式除颤器（n=95）或常规药物治疗（n=101）。我们采用双侧连续设计，以任何原因导致的死亡作为终点。结果两组患者基线特征相似。在平均27个月的随访期间，除颤器组有15人死亡（11人死于心脏原因），常规治疗组有39人死亡（27人死于心脏原因）（总死亡率的风险比为0.46；95%可信区间为0.26至0.82；P=0.009）。没有证据表明胺碘酮、受体阻滞剂或任何其他抗心律失常治疗对观察到的危险比有显著影响。结论：对于既往有室性心动过速高风险的心肌梗死患者，与常规药物治疗相比，植入式除颤器预防性治疗可提高生存率。(C) 1996年，马萨诸塞州医学会。
Background Unsustained ventricular tachycardia in patients with previous myocardial infarction and left ventricular dysfunction is associated with a two-year mortality rate of about 30 percent. We studied. whether prophylactic therapy with an implanted cardioverter-defibrillator, as compared with conventional medical therapy, would improve survival in this high-risk group of patients.Methods Over the course of five years, 196 patients in New York Heart Association functional class I, II, or III with prior myocardial infarction; a left ventricular ejection fraction less than or equal to 0.35; a documented episode of asymptomatic unsustained ventricular tachycardia; and inducible, nonsuppressible ventricular tachyarrhythmia on electrophysiologic study were randomly assigned to receive an implanted defibrillator (n=95) or conventional medical therapy (n=101). We used a two-sided sequential design with death from any cause as the end point.Results The base-line characteristics of the two treatment groups were similar. During an average follow-up of 27 months, there were 15 deaths in the defibrillator group (11 from cardiac causes) and 39 deaths in the conventional-therapy group (27 from cardiac causes) (hazard ratio for overall mortality, 0.46; 95 percent confidence interval, 0.26 to 0.82; P=0.009). There was no evidence that amiodarone, beta-blockers, or any other antiarrhythmic therapy had a significant influence on the observed hazard ratio.Conclusions In patients with a prior myocardial infarction who are at high risk for ventricular tachyarrhythmia, prophylactic therapy with an implanted defibrillator leads to improved survival as compared with conventional medical therapy. (C) 1996, Massachusetts Medical Society.