Coleman Craig I, Kluger Jeffrey, Bhavnani Sanjeev, Clyne Christopher, Yarlagadda Ravi, Guertin Danette, White C Michael
Division of Cardiology, Hartford Hospital, and University of Connecticut Schools of Pharmacy and Medicine, Storrs and Farmington, Connecticut 06102-5037, USA.
Heart Rhythm. 2008 Apr;5(4):507-10. doi: 10.1016/j.hrthm.2007.12.023. Epub 2007 Dec 27.
A few previous nested cohort trials have evaluated the use of statins on survival and the occurrence of ventricular tachycardia or fibrillation (VT/VF). While the studies generally agreed on the survival effects, they disagreed on the magnitude of the mortality benefit and on the effect on VT/VF.
The purpose of this study was to determine in a large, long-term follow-up cohort whether statin therapy could reduce mortality and the occurrence of VT/VF in a mixed population receiving an implantable cardioverter-defibrillator (ICD) for primary or secondary prevention and either ischemic or nonischemic cardiomyopathy.
Cohort evaluation of all patients undergoing implantation of an ICD with a left ventricular ejection fraction <40% at an urban U.S. teaching hospital from December 1997 through January 2007. Multivariable analysis of predictors of mortality and VT/VF were conducted.
There were 314 deaths among the 1204 patients (26.1%). The use of statin therapy (n = 642) was associated with an adjusted hazard ratio of 0.67 (95% confidence interval [CI] 0.53-0.85; P<.001) for mortality as compared with the no-statin group (n = 562). The use of statin therapy was not associated with a reduction in the adjusted hazard ratio for VT/VF (0.85; 95% CI 0.68-1.06; P = .14).
Statin therapy is associated with a reduction in overall mortality in patients with ischemic or nonischemic cardiomyopathy with an ICD implanted for either primary or secondary prevention. The magnitude of survival benefit might have been underestimated given our inability to use statin as a time-dependent covariate.
先前有几项巢式队列试验评估了他汀类药物对生存率以及室性心动过速或颤动（VT/VF）发生情况的影响。虽然这些研究在生存效应方面总体上达成了共识，但在死亡率获益的程度以及对VT/VF的影响方面存在分歧。
本研究的目的是在一个大型的长期随访队列中确定，他汀类药物治疗能否降低接受植入式心脏复律除颤器（ICD）进行一级或二级预防且患有缺血性或非缺血性心肌病的混合人群的死亡率和VT/VF的发生率。
对1997年12月至2007年1月在美国一家城市教学医院接受ICD植入且左心室射血分数<40%的所有患者进行队列评估。对死亡率和VT/VF的预测因素进行多变量分析。
1204例患者中有314例死亡（26.1%）。与未使用他汀类药物的组（n = 562）相比，使用他汀类药物治疗（n = 642）的患者死亡率的调整后风险比为0.67（95%置信区间[CI] 0.53 - 0.85；P <.001）。使用他汀类药物治疗与VT/VF调整后风险比的降低无关（0.85；95% CI 0.68 - 1.06；P = 0.14）。
他汀类药物治疗与植入ICD进行一级或二级预防的缺血性或非缺血性心肌病患者的总体死亡率降低相关。鉴于我们无法将他汀类药物用作时间依赖性协变量，生存获益的程度可能被低估了。
