β受体阻滞剂在心室颤动或有症状室性心动过速患者中的应用与生存情况：抗心律失常药物与植入式除颤器（AVID）试验

Beta-blocker use and survival in patients with ventricular fibrillation or symptomatic ventricular tachycardia: the Antiarrhythmics Versus Implantable Defibrillators (AVID) trial.

作者信息

Exner D V, Reiffel J A, Epstein A E, Ledingham R, Reiter M J, Yao Q, Duff H J, Follmann D, Schron E, Greene H L, Carlson M D, Brodsky M A, Akiyama T, Baessler C, Anderson J L

机构信息

National Heart, Lung, and Blood Institute, Bethesda, Maryland 20892, USA.

出版信息

J Am Coll Cardiol. 1999 Aug;34(2):325-33. doi: 10.1016/s0735-1097(99)00234-x.

DOI:10.1016/s0735-1097(99)00234-x

PMID:10440140

Abstract

OBJECTIVES

To evaluate whether use of beta-adrenergic blocking agents, alone or in combination with specific antiarrhythmic therapy, is associated with improved survival in persons with ventricular fibrillation (VF) or symptomatic ventricular tachycardia (VT).

BACKGROUND

The ability of beta-blockers to alter the mortality of patients with VF or VT receiving contemporary medical management is not well defined.

METHODS

Survival of 1,016 randomized and 2,101 eligible, nonrandomized patients with VF or symptomatic VT followed in the Antiarrhythmics Versus Implantable Defibrillators (AVID) trial through December 31, 1996 was assessed using Cox proportional hazards analysis.

RESULTS

The 817 (28%) patients discharged from hospital receiving beta-blockers had less ventricular dysfunction, fewer symptoms of heart failure and a different pattern of medication use compared with patients not receiving beta-blockers. Before adjustment for important prognostic variables, beta-blockade was not significantly associated with survival in randomized or in eligible, nonrandomized patients treated with specific antiarrhythmic therapy. After adjustment, beta-blockade remained unrelated to survival in randomized or in eligible, nonrandomized patients treated with amiodarone alone (n = 1142; adjusted relative risk [RR] = 0.96; 95% confidence interval [CI] 0.64-1.45; p = 0.85) or a defibrillator alone (n = 1347; adjusted RR = 0.88; 95% CI 0.55 to 1.40; p = 0.58). In contrast, beta-blockade was independently associated with improved survival in eligible, nonrandomized patients who were not treated with specific antiarrhythmic therapy (n = 412; adjusted RR = 0.47; 95% CI 0.25 to 0.88; p = 0.018).

CONCLUSIONS

Beta-blocker use was independently associated with improved survival in patients with VF or symptomatic VT who were not treated with specific antiarrhythmic therapy, but a protective effect was not prominent in patients already receiving amiodarone or a defibrillator.

摘要

目的

评估单独使用β-肾上腺素能阻滞剂或与特定抗心律失常治疗联合使用，是否能提高心室颤动（VF）或有症状室性心动过速（VT）患者的生存率。

背景

β受体阻滞剂对接受当代医学治疗的VF或VT患者死亡率的影响尚不明确。

方法

采用Cox比例风险分析评估了抗心律失常药物与植入式除颤器（AVID）试验中1016例随机分组患者以及2101例符合条件的非随机分组患者（VF或有症状VT）至1996年12月31日的生存率。

结果

与未接受β受体阻滞剂治疗的患者相比，817例（28%）出院时接受β受体阻滞剂治疗的患者心室功能障碍较少，心力衰竭症状较少，用药模式也有所不同。在对重要预后变量进行调整之前，β受体阻滞剂治疗与接受特定抗心律失常治疗的随机分组患者或符合条件的非随机分组患者的生存率无显著相关性。调整后，β受体阻滞剂治疗与单独接受胺碘酮治疗的随机分组患者或符合条件的非随机分组患者（n = 1142；调整后相对风险[RR] = 0.96；95%置信区间[CI] 0.64 - 1.45；p = 0.85）或单独接受除颤器治疗的患者（n = 1347；调整后RR = 0.88；95% CI 0.55至1.40；p = 0.58）的生存率仍无关联。相比之下，β受体阻滞剂治疗与未接受特定抗心律失常治疗的符合条件的非随机分组患者（n = 412；调整后RR = 0.47；95% CI 0.25至0.88；p = 0.018）的生存率提高独立相关。