ICD可提高LVEF 30~35%患者生存率
《美国医学会杂志》6月4日刊发的一项回顾性队列研究显示,与未使用预防性植入式心律转复除颤器(ICD)的匹配患者相比,左心室射血分数(LVEF)30~35%的心衰患者使用预防性ICD与3年生存率改善相关(JAMA 2014;311:2209-15)。
杜克大学的Sana M. Al-Khatib博士及其同事报告称,接受预防性ICD的408例LVEF 30~35%患者3年全因死亡率为51.4%,而未接受预防性ICD的408例匹配对照者为55%[风险比(HR),0.83];接受预防性ICD的1,088例LVEF<30%患者3年全因死亡率为45%,而未接受预防性ICD的1,088例匹配对照者为57.6%(HR,0.72)。
ICD使用者为2006~2007年全美心血管数据登记库(NCDR)中ICD登记的联邦医疗保险受益者,对照者为2005~2009年遵循指南-心衰(GWTG-HF)数据库中的匹配患者。
既往预防性ICD使用研究仅纳入少部分LVEF30~35%患者,这项最新研究结果证实了这类患者获益“非常显著”,支持了指南推荐的LVEF≤35%的符合条件患者应使用预防性ICD的意见。
该项研究由美国国立心肺血液研究所基金资助,Al-Khatib博士无利益冲突披露,其他作者的详细披露参见全文。
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Prophylactic implantable cardioverter-defibrillator use was associated with improved 3-year survival in Medicare beneficiaries with heart failure and a left ventricular ejection fraction of 30%-35% and in those with LVEF less than 30%, compared with no prophylactic ICD use in comparable patients in a retrospective cohort study.
All-cause mortality at 3 years in 408 patients with LVEF of 30% -35% who received a prophylactic ICD was 51.4%, compared with 55% in 408 matched controls without an ICD (hazard ratio, 0.83). The all-cause mortality rates at 3 years in 1,088 patients with LVEF of less than 30% was 45% in those with a prophylactic ICD vs. 57.6% in 1,088 matched controls without an ICD (HR, 0.72), Dr. Sana M. Al-Khatib of Duke University, Durham, N.C., and her colleagues reported in the June 4 issue of JAMA.
Study subjects were Medicare beneficiaries in the National Cardiovascular Data Registry ICD registry during 2006-2007, and similar patients in the Get With the Guidelines-Heart Failure database during 2005-2009 (JAMA 2014;311:2209-15).
Prior studies of prophylactic ICD use have included only a minority of patients with LVEF of 30%-35%; the current findings demonstrate a "clearly significant" benefit in this population and support guideline recommendations calling for prophylactic ICD use in eligible patients with an LVEF of 35% or less, the investigators conclude d.
This study was funded by a National Heart, Lung, and Blood Institute grant. Dr. Al-Khatib reported having no disclosures. Detailed disclosures for several of the other study authors are available with the full text of the article at jama.com.
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