晚期心力衰竭的死亡方式：心力衰竭中医疗、起搏和除颤治疗比较（COMPANION）试验

Mode of death in advanced heart failure: the Comparison of Medical, Pacing, and Defibrillation Therapies in Heart Failure (COMPANION) trial.

作者信息

Carson Peter, Anand Inder, O'Connor Christopher, Jaski Brian, Steinberg Jonathan, Lwin Amy, Lindenfeld JoAnn, Ghali Jalal, Barnet Jodi H, Feldman Arthur M, Bristow Michael R

机构信息

Division of Cardiology, Veterans Affairs Medical Center, Washington, DC 20422, USA.

出版信息

J Am Coll Cardiol. 2005 Dec 20;46(12):2329-34. doi: 10.1016/j.jacc.2005.09.016.

DOI:10.1016/j.jacc.2005.09.016

PMID:16360067

Abstract

OBJECTIVES

The aim of this study was to evaluate the mode of death in patients with advanced chronic heart failure (HF) and intraventricular conduction delay treated with optimal pharmacologic therapy (OPT) alone or OPT with biventricular pacing to provide cardiac resynchronization therapy (CRT) or CRT + an implantable defibrillator (CRT-D).

BACKGROUND

Limited data are available on mode of death in advanced HF. No data have existed on mode of death in these patients who also have an intraventricular conduction delay and are treated with CRT or CRT-D.

METHODS

Using prespecified definitions and source materials, seven cardiologists assessed mode of death among the 313 deaths that occurred in the Comparison of Medical, Pacing, and Defibrillation Therapies in Heart Failure (COMPANION) trial.

RESULTS

A primary cardiac cause was present in 78% of deaths. Pump failure (44.4%) was the most common mode of death followed by sudden cardiac death (SCD) (26.5%). Compared with OPT, CRT-D significantly reduced the number of cardiac deaths (38%, p = 0.006), whereas CRT alone was associated with a non-significant 14.5% reduction (p = 0.33). Both CRT and CRT-D tended to reduce pump failure deaths (29%, p = 0.11 and 27%, p = 0.14, respectively). The CRT-D significantly reduced SCD (56%, p = 0.02), but CRT alone did not.

CONCLUSIONS

Pump failure deaths are the predominant mode of death in patients with advanced HF and are modestly reduced by both CRT and CRT-D. Only CRT-D reduced SCD and thus produced a favorable effect on cardiac mortality.

摘要

目的

本研究旨在评估单纯接受最佳药物治疗（OPT）或接受双心室起搏以提供心脏再同步治疗（CRT）或CRT +植入式除颤器（CRT-D）的晚期慢性心力衰竭（HF）合并室内传导延迟患者的死亡方式。

背景

关于晚期HF患者死亡方式的数据有限。对于这些合并室内传导延迟且接受CRT或CRT-D治疗的患者，尚无关于死亡方式的数据。

方法

7名心脏病专家使用预先设定的定义和原始资料，评估了心力衰竭的药物、起搏和除颤治疗比较（COMPANION）试验中发生的313例死亡病例的死亡方式。

结果

78%的死亡病例存在主要心脏病因。泵衰竭（44.4%）是最常见的死亡方式，其次是心源性猝死（SCD）（26.5%）。与OPT相比，CRT-D显著减少了心脏死亡病例数（38%，p = 0.006），而单纯CRT使心脏死亡病例数减少了14.5%，但差异无统计学意义（p = 0.33）。CRT和CRT-D均倾向于减少泵衰竭死亡病例（分别为29%，p = 0.11和27%，p = 0.14）。CRT-D显著减少了SCD（56%，p = 0.02），但单纯CRT未减少。