Ahmed Ali, Rich Michael W, Love Thomas E, Lloyd-Jones Donald M, Aban Inmaculada B, Colucci Wilson S, Adams Kirkwood F, Gheorghiade Mihai
University of Alabama at Birmingham, VA Medical Center, 1530 3rd Avenue South, CH-19, Ste-219, Birmingham, AL 35294-2041, USA.
Eur Heart J. 2006 Jan;27(2):178-86. doi: 10.1093/eurheartj/ehi687. Epub 2005 Dec 8.
To determine the effects of digoxin on all-cause mortality and heart failure (HF) hospitalizations, regardless of ejection fraction, accounting for serum digoxin concentration (SDC).
This comprehensive post-hoc analysis of the randomized controlled Digitalis Investigation Group trial (n=7788) focuses on 5548 patients: 1687 with SDC, drawn randomly at 1 month, and 3861 placebo patients, alive at 1 month. Overall, 33% died and 31% had HF hospitalizations during a 40-month median follow-up. Compared with placebo, SDC 0.5-0.9 ng/mL was associated with lower mortality [29 vs. 33% placebo; adjusted hazard ratio (AHR), 0.77; 95% confidence interval (CI), 0.67-0.89], all-cause hospitalizations (64 vs. 67% placebo; AHR, 0.85; 95% CI, 0.78-0.92) and HF hospitalizations (23 vs. 33% placebo; AHR, 0.62; 95% CI, 0.54-0.72). SDC> or =1.0 ng/mL was associated with lower HF hospitalizations (29 vs. 33% placebo; AHR, 0.68; 95% CI, 0.59-0.79), without any effect on mortality. SDC 0.5-0.9 reduced mortality in a wide spectrum of HF patients and had no interaction with ejection fraction >45% (P=0.834) or sex (P=0.917).
Digoxin at SDC 0.5-0.9 ng/mL reduces mortality and hospitalizations in all HF patients, including those with preserved systolic function. At higher SDC, digoxin reduces HF hospitalization but has no effect on mortality or all-cause hospitalizations.
确定地高辛对全因死亡率和心力衰竭（HF）住院率的影响，无论射血分数如何，并考虑血清地高辛浓度（SDC）。
这项对随机对照的地高辛研究组试验（n = 7788）进行的全面事后分析聚焦于5548例患者：1687例在1个月时随机抽取的有SDC数据的患者，以及3861例在1个月时存活的安慰剂组患者。总体而言，在40个月的中位随访期内，33%的患者死亡，31%的患者因HF住院。与安慰剂相比，SDC为0.5 - 0.9 ng/mL与较低的死亡率相关[安慰剂组为33%，SDC为0.5 - 0.9 ng/mL组为29%；调整后风险比（AHR）为0.77；95%置信区间（CI）为0.67 - 0.89]、全因住院率（安慰剂组为67%，SDC为0.5 - 0.9 ng/mL组为64%；AHR为0.85；95% CI为0.78 - 0.92）以及HF住院率（安慰剂组为33%，SDC为0.5 - 0.9 ng/mL组为23%；AHR为0.62；95% CI为0.54 - 0.72）。SDC≥1.0 ng/mL与较低的HF住院率相关（安慰剂组为33%，SDC≥1.0 ng/mL组为29%；AHR为0.68；95% CI为0.59 - 0.79），但对死亡率无任何影响。SDC为0.5 - 0.9可降低广泛类型HF患者的死亡率，且与射血分数>45%（P = 0.834）或性别（P = 0.917）无相互作用。
SDC为0.5 - 0.9 ng/mL的地高辛可降低所有HF患者的死亡率和住院率，包括收缩功能保留的患者。在较高的SDC水平下，地高辛可降低HF住院率，但对死亡率或全因住院率无影响。
