Cardiology Division, Heart Research Follow-up Program, University of Rochester Medical Center, Rochester, NY, USA.
Eur Heart J. 2011 Jul;32(13):1614-21. doi: 10.1093/eurheartj/ehq392. Epub 2010 Nov 12.
Cardiac remodelling is a progressive process after myocardial infarction (MI). However, currently there are no data regarding the effect of s:elapsed time from MI on the benefit of cardiac resynchronization therapy with defibrillator (CRT-D). The present study was designed to evaluate the relationship between elapsed time from MI and the benefit of preventive CRT-D therapy in patients with ischaemic cardiomyopathy (ICM).
The risk of heart failure (HF) or death as a function of elapsed time from MI to enrolment, by treatment with CRT-D vs. implantable cardioverter defibrillator (ICD)-only therapy, was assessed among 704 ICM patients with a documented MI enrolled in MADIT-CRT, and separately in a subset of ICM patients without a documented prior MI (n = 237). In ICD patients, the adjusted risk of HF or death increased by 4% (P = 0.01) for each year elapsed from MI. Multivariate analysis demonstrated that patients with remote MI [categorized at the median value (≥8 years)] derived a significantly greater benefit from CRT-D [HR = 0.42 (P < 0.001)] than those with a more recent MI [HR = 1.26 (P = 0.35); P-value for interaction <0.001]. Consistently, the benefit of CRT-D was directly related to increasing quartiles of elapsed time from MI [Q(1) (<3 years): HR = 1.67; P = 0.20, Q(2) (3-8 years): HR = 1.12; P = 0.71, Q(3) (8-15 years): HR = 0.47; P = 0.02, and Q(4) (≥15 years): HR = 0.38; P = 0.001]. The ICM subgroup with no documented MI also derived enhanced benefit from CRT-D (HR = 0.43; P = 0.003).
In patients with ischaemic cardiomyopathy, the risk of HF or death and the magnitude of CRT-D benefit are directly related to elapsed time from MI.
心肌梗死后（MI），心肌重构是一个进行性的过程。然而，目前尚无数据表明 MI 发生后时间对心脏再同步化治疗除颤器（CRT-D）的预防作用的影响。本研究旨在评估 MI 发生后时间与缺血性心肌病（ICM）患者接受预防性 CRT-D 治疗获益之间的关系。
在 MADIT-CRT 研究中，纳入了 704 例有记录的 MI 的 ICM 患者，评估了从 MI 发病到入组时接受 CRT-D 治疗与单独植入式心脏复律除颤器（ICD）治疗的心力衰竭（HF）或死亡风险的函数关系，并在无记录的既往 MI（n = 237）的 ICM 患者亚组中进行了单独评估。在 ICD 患者中，每经过一年 MI，HF 或死亡的调整风险增加 4%（P = 0.01）。多变量分析表明，MI 时间较长的患者（以中位数（≥8 年）分类），从 CRT-D 治疗中获益显著更大[HR = 0.42（P < 0.001）]，而 MI 时间较短的患者获益较小[HR = 1.26（P = 0.35）；P 值<0.001]。同样，CRT-D 的获益与 MI 后时间的四分位数呈直接相关[Q1（<3 年）：HR = 1.67；P = 0.20，Q2（3-8 年）：HR = 1.12；P = 0.71，Q3（8-15 年）：HR = 0.47；P = 0.02，Q4（≥15 年）：HR = 0.38；P = 0.001]。无记录 MI 的 ICM 亚组也从 CRT-D 治疗中获益增强（HR = 0.43；P = 0.003）。
在缺血性心肌病患者中，HF 或死亡风险和 CRT-D 获益的幅度与 MI 后时间直接相关。
