Foley Paul W X, Addison Clara E, Whinney Stephanie B, Patel Kiran, Cunningham David, Frenneaux Michael P, Leyva Francisco
University of Birmingham, Good Hope Hospital, Sutton Coldfield, UK.
Pacing Clin Electrophysiol. 2009 Mar;32 Suppl 1:S131-4. doi: 10.1111/j.1540-8159.2008.02268.x.
To estimate the proportion of patients eligible for implantable cardioverter defibrillator (ICD) therapy for the primary prevention of sudden cardiac death after a myocardial infarction (MI), according to the current guidelines.
Eligibility was assessed retrospectively at 6 weeks in 513 post-MI survivors (age 66 +/- 13 years, left ventricular ejection fraction 48.2 +/- 17%) on the basis of an electrocardiogram and an echocardiogram.
LVEF was < or = 40% in 37% and < or = 35% in 30%, and QRS duration was <120 ms in 89% and > or =120 ms in 11% of patients. The proportion of post-MI patients meeting the criteria set by guidelines were 37% for 2006 American College of Cardiology/American Heart Association/European Society of Cardiology (ACC/AHA/ESC) 26.5% for 2008 ACC/AHA/Canadian Heart Rhythm Society 16.3% for 2005 US Centers for Medicare and Medicaid Services (CMS), and 5.8% for the 2006 United Kingdom (UK) National Institute of Clinical Excellence (NICE). According to 2005 CMS and 2006 UK-NICE guidelines, Holter monitoring was required in 7% and 18%, respectively. For the United States (700,000 MI in 2006), the 2006 ACC/AHA/ESC guidelines equate to 216,783 ICD implantations/year. For UK (60,499 MI in 2006), the 2006 NICE guidelines equate to 2,941 ICD implantations, 10,488 Holter studies, and 1,065 VT induction tests/year.
Current ICD therapy guidelines for primary prevention of SCD post-MI demand a substantial increase in service provision worldwide.
根据现行指南，评估心肌梗死（MI）后适合植入式心律转复除颤器（ICD）治疗以进行心脏性猝死一级预防的患者比例。
基于心电图和超声心动图，对513例心肌梗死后存活者（年龄66±13岁，左心室射血分数48.2±17%）在6周时进行回顾性评估。
37%的患者左心室射血分数（LVEF）≤40%，30%的患者LVEF≤35%；89%的患者QRS波时限<120毫秒，11%的患者QRS波时限≥120毫秒。符合指南设定标准的心肌梗死后患者比例，2006年美国心脏病学会/美国心脏协会/欧洲心脏病学会（ACC/AHA/ESC）为37%，2008年ACC/AHA/加拿大心律协会为26.5%，2005年美国医疗保险和医疗补助服务中心（CMS）为16.3%，2006年英国国家临床优化研究所（NICE）为5.8%。根据2005年CMS和2006年英国NICE指南，分别有7%和18%的患者需要进行动态心电图监测。对于美国（2006年有70万例心肌梗死），2006年ACC/AHA/ESC指南相当于每年植入216,783台ICD。对于英国（2006年有60,499例心肌梗死），2006年NICE指南相当于每年植入2,941台ICD、进行10,488次动态心电图检查以及1,065次室性心动过速诱发试验。
目前关于心肌梗死后心脏性猝死一级预防的ICD治疗指南要求全球范围内大幅增加服务提供。
