Department of Internal Medicine, University of Rochester Medical Center, Rochester, New York 14642, USA.
J Cardiovasc Electrophysiol. 2011 Aug;22(8):892-7. doi: 10.1111/j.1540-8167.2011.02011.x.
Elderly patients comprise a large portion of patients with heart failure (HF). Limited data exist on the effectiveness of cardiac resynchronization therapy with defibrillator (CRT-D) in patients with mild HF symptoms in this population.
The benefit of CRT-D compared with ICD-only therapy in reducing HF or death was assessed by age categories (prespecified as <60 [n = 548], 60-74 [n = 941], and ≥75 [n = 331] years) among 1,820 patients in MADIT-CRT. In patients with ICD-only, there was a graded age-related increase in the Kaplan-Meier cumulative probability of HF or death at 3-year follow-up (19%, 33%, and 36%, in patients aged <60, 60-74, and ≥75 years, respectively, P = 0.003). Multivariate analysis demonstrated that CRT-D therapy was associated with a significant reduction in the risks of HF or death in patients aged 60-74, and ≥75 years (HR = 0.57, P = <0.001 and HR = 0.59, P = 0.017, respectively), and no significant benefit in patients aged <60 years (HR = 0.81, P = 0.3; P-value for all treatment-by-age interactions >0.10). There was no significant difference in the rate of device-related adverse events within 90 days following CRT-D implantation among age-subgroups (16.7%, 15.7%, and 11.7%, in patients <60, 60-74, and ≥75 years, respectively, P = 0.42).
CRT-D was associated with a significant clinical benefit in older patients (≥60 years) during an average 2.4-year follow-up. These effects were preserved for the elderly patients ≥75 years of age but attenuated in patients <60 years. Elderly patients had no increase in device-related adverse events compared with younger patients.
心力衰竭（HF）患者中老年人占很大比例。在该人群中，对于轻度 HF 症状的患者，心脏再同步治疗除颤器（CRT-D）的有效性数据有限。
在 1820 例 MADIT-CRT 患者中，按年龄分类（<60[n=548]、60-74[n=941]和≥75[n=331]岁）评估 CRT-D 与 ICD 单独治疗相比在减少 HF 或死亡方面的益处。在接受 ICD 单独治疗的患者中，Kaplan-Meier 累积 3 年随访时 HF 或死亡的累积概率呈年龄相关梯度增加（<60 岁、60-74 岁和≥75 岁的患者分别为 19%、33%和 36%，P=0.003）。多变量分析表明，在 60-74 岁和≥75 岁的患者中，CRT-D 治疗与 HF 或死亡风险的显著降低相关（HR=0.57，P<0.001 和 HR=0.59，P=0.017），而在<60 岁的患者中没有明显获益（HR=0.81，P=0.3；所有治疗与年龄相互作用的 P 值>0.10）。在 CRT-D 植入后 90 天内，年龄亚组之间的器械相关不良事件发生率无显著差异（<60 岁、60-74 岁和≥75 岁的患者分别为 16.7%、15.7%和 11.7%，P=0.42）。
在平均 2.4 年的随访中，CRT-D 与老年患者（≥60 岁）的显著临床获益相关。这些效果在≥75 岁的老年患者中得到保留，但在<60 岁的患者中减弱。与年轻患者相比，老年患者的器械相关不良事件没有增加。
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