Cardiac Arrhythmia Service, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, GRB 109, Boston, MA 02114, USA.
Europace. 2010 Dec;12(12):1745-9. doi: 10.1093/europace/euq319. Epub 2010 Sep 18.
It remains unclear whether cardiac resynchronization therapy (CRT) device implantation during inpatient (IP) hospitalization affords the same benefit as elective outpatient (OP) implantation. We hypothesized that IPs undergoing CRT device implantation during acute hospitalization may have worse outcomes compared with elective OP implantation.
We retrospectively separated patients undergoing CRT implants at Massachusetts General Hospital into OP (n= 196) and IP (n = 105) cohorts. Long-term outcomes, measured as heart failure (HF) hospitalization, all-cause mortality, ventricular assist device placement, or heart transplant over a 2-year follow-up period, were estimated by the Kaplan-Meier method. Propensity scores were generated to balance the baseline co-morbidities between IP and OP. Baseline age, gender, left ventricular ejection fraction, and aetiology of cardiomyopathy were comparable between OP and IP (66.8 ± 11.8 vs. 67.5 ± 13.4 years, 78 vs. 84% males, 24 vs. 23%, and 39 vs. 50% ischaemic, P = NS). Inpatients had greater burden of diabetes mellitus (40 vs. 27%, P = 0.028), renal insufficiency (47 vs. 25%, P< 0.001), and right ventricular dysfunction (54 vs. 39%, P = 0.026) compared with OPs. At 2-year follow-up, IP implant was associated with greater risk of HF hospitalization (HR 1.6, 95% CI 1.03-2.48, P = 0.038) compared with elective OP implants. After propensity score adjustment, there was no statistically significant difference in HF hospitalization between the IP and OP groups (HR 1.031, 95% CI 0.61-1.78, P = 0.91).
Compared with OP CRT implants, IPs are at increased risk for recurrent HF hospitalization; however, the increased risk is attributable to greater co-morbidities in the IP population.
心脏再同步治疗（CRT）装置的植入在住院期间（IP）和门诊（OP）进行，其效果是否相同尚不清楚。我们假设，与择期 OP 植入相比，急性住院期间植入 CRT 装置的 IP 患者的预后可能更差。
我们回顾性地将在马萨诸塞州总医院接受 CRT 植入的患者分为 OP（n=196）和 IP（n=105）两组。通过 Kaplan-Meier 方法估计 2 年随访期间心力衰竭（HF）住院、全因死亡率、心室辅助装置植入或心脏移植的长期预后。生成倾向评分以平衡 IP 和 OP 之间的基线合并症。OP 和 IP 之间的基线年龄、性别、左心室射血分数和心肌病病因相似（66.8±11.8 岁比 67.5±13.4 岁，78%比 84%为男性，24%比 23%为扩张型，39%比 50%为缺血性，P=NS）。与 OP 相比，IP 患者的糖尿病（40%比 27%，P=0.028）、肾功能不全（47%比 25%，P<0.001）和右心室功能障碍（54%比 39%，P=0.026）更为严重。在 2 年的随访中，与择期 OP 植入相比，IP 植入与 HF 住院风险增加相关（HR 1.6，95%CI 1.03-2.48，P=0.038）。在进行倾向评分调整后，IP 组与 OP 组之间的 HF 住院率无统计学差异（HR 1.031，95%CI 0.61-1.78，P=0.91）。
与 OP CRT 植入相比，IP 患者 HF 再住院的风险增加；然而，这种风险增加归因于 IP 人群中合并症更多。
