Giedrimas Arnoldas, Giedrimiene Dalia, Guertin Danette, White C Michael, Clyne Christopher A, Kluger Jeffrey
University of Connecticut School of Pharmacy, Farmington, USA.
Conn Med. 2008 Jun-Jul;72(6):329-33.
Compare characteristics and outcomes of patients receiving implantable cardioverter defibrillators (ICDs) for primary vs secondary cardiac arrest prevention.
Patients in this cohort study were identified from a prospectively collected ICD database from June 1999 to August 2003 and divided into groups based on whether they received their ICD for primary or secondary-prevention of cardiac arrest. Patient follow-up continued until August of 2006 and the occurrence of appropriate ICD shocks, inappropriate ICD shocks, and mortality were compared between groups.
Of the 437 patients, 80.8% were male, 70.3% had coronary disease, and the mean age was 65.7+/-13.1 years. At baseline, primary-prevention patients had lower left ventricular ejection fraction (LVEF), use of a single chamber device and utilization of beta blockers and antiarrhythmics while having a greater use of biventricular pacing as compared to secondary-prevention patients. Over the first 12 months after implantation, the primary-prevention group was 43.0% less likely to receive an appropriate shock for ventricular arrhythmias (P=0.002) and 34.2% less likely to have an appropriate shock over the entire follow-up period (P=0.018). The incidence of inappropriate ICD shocks over the first 12 months after implantation and over the entire follow-up period was similar between groups (P=0.900 and P=0.217, respectively) as was mortality (P=0.228 and P=0.757, respectively).
Primary-prevention patients are characteristically different in numerous ways from secondary-prevention patients, but despite having a greater risk of experiencing appropriate shocks, exhibit a similar risk of inappropriate shocks and mortality over an average follow-up time exceeding 41 months.
比较接受植入式心脏复律除颤器（ICD）用于一级预防与二级预防心脏骤停患者的特征及预后。
本队列研究中的患者来自1999年6月至2003年8月前瞻性收集的ICD数据库，并根据其接受ICD是用于心脏骤停的一级预防还是二级预防进行分组。患者随访持续至2006年8月，比较两组间适当ICD电击、不适当ICD电击及死亡率的发生情况。
437例患者中，80.8%为男性，70.3%患有冠心病，平均年龄为65.7±13.1岁。基线时，与二级预防患者相比，一级预防患者的左心室射血分数（LVEF）较低，使用单腔装置以及使用β受体阻滞剂和抗心律失常药物的情况较少，而双心室起搏的使用较多。在植入后的前12个月内，一级预防组因室性心律失常接受适当电击的可能性降低43.0%（P = 0.002），在整个随访期间接受适当电击的可能性降低34.2%（P = 0.018）。两组在植入后前12个月及整个随访期间不适当ICD电击的发生率相似（分别为P = 0.900和P = 0.217），死亡率也相似（分别为P = 0.228和P = 0.757）。
一级预防患者在许多方面与二级预防患者存在特征性差异，但尽管发生适当电击的风险较高，但在平均超过41个月的随访时间内，不适当电击和死亡的风险相似。
