Levy Ronni, DellaValle Andrea, Atav A Serdar, ur Rehman Afazal, Sklar Allan H, Stamato Nicolas J
Columbia University, New York, New York, USA.
Clin Cardiol. 2008 Jun;31(6):265-9. doi: 10.1002/clc.20209.
We explored the association between renal insufficiency (RI) and mortality among patients treated with an implantable cardioverter defibrillator (ICD).
Randomized trials have shown improvements in survival among select patients treated with an ICD. Renal insufficiency patients have a high risk of cardiac death; however, it is not clear whether the ICD has a positive effect on survival in this group of patients.
This was a retrospective review of a single-center experience of 346 patients treated with an ICD. Patients were stratified into 4 groups according to their glomerular filtration rate (eGFR; expressed as mL/min/ -1.73 m(2)) at implantation: group I, > 75.0; group II, - 60.0 to 74.9; group III, - 45.0 to 59.9; and group IV, - < or = 45.0. All-cause mortality was the primary end point, with differences in survival times among the 4 groups of patients expressed in Kaplan-Meier curves.
Mean follow-up was 3.5 y (range 0.1 to 12.9 y), during which 67 patients died (19%). Mortality in each eGFR group was: I - 6.8%, II - 13.8%, III - 11.5%, IV - 45.8% (p < 0.001). Survival times (mean, y) were I, 3.74; II, 3.66; III, 3.38, and IV, 2.82. The presence of diabetes was not a factor in the outcomes.
Patients treated with an ICD with an eGFR of < or = 45.0 mL/min/1.73 m(2) have a significantly shorter survival time than those patients with an eGFR > 45.0 mL/min/1.73 m(2). Patients with an eGFR > 45.0 mL/min/1.73 m(2) appear to have equally good outcomes when treated with an ICD. This may have implications for patient selection for ICD therapy.
我们探讨了植入式心脏复律除颤器（ICD）治疗患者的肾功能不全（RI）与死亡率之间的关联。
随机试验表明，部分接受ICD治疗的患者生存率有所提高。肾功能不全患者心脏死亡风险较高；然而，ICD对该组患者的生存是否具有积极作用尚不清楚。
这是一项对346例接受ICD治疗患者的单中心经验回顾性研究。患者根据植入时的肾小球滤过率（eGFR；以mL/min/ -1.73 m²表示）分为4组：I组，> 75.0；II组，- 60.0至74.9；III组，- 45.0至59.9；IV组，- <或 = 45.0。全因死亡率是主要终点，4组患者生存时间的差异用Kaplan-Meier曲线表示。
平均随访3.5年（范围0.1至12.9年），在此期间67例患者死亡（19%）。各eGFR组的死亡率分别为：I组 - 6.8%，II组 - 13.8%，III组 - 11.5%，IV组 - 45.8%（p < 0.001）。生存时间（平均，年）分别为：I组，3.74；II组，3.66；III组，3.38，IV组，2.82。糖尿病的存在不是影响预后的因素。
eGFR≤45.0 mL/min/1.73 m²的接受ICD治疗的患者比eGFR>45.0 mL/min/1.73 m²的患者生存时间明显更短。eGFR>45.0 mL/min/1.73 m²的患者接受ICD治疗时似乎有同样良好的预后。这可能对ICD治疗的患者选择有影响。
