Clinica Mediterranea, Naples, Italy.
J Cardiovasc Med (Hagerstown). 2013 Feb;14(2):110-3. doi: 10.2459/JCM.0b013e3283511f5b.
Less than 50% of patients implanted with an implantable cardioverter-defibrillator (ICD) receive device therapy during the follow-up. The aim of our study was to prospectively evaluate the predictive role of appropriate ICD therapy on long-term survival of patients implanted for primary or secondary sudden death prevention.
From 2002 to 2003, 139 consecutive patients [mean age 66±9 years, male 77%, ischemic heart disease 56%, New York Heart Association functional class >II (74%), primary prevention 74%, mean left ventricular ejection fraction 30±9%, cardiac resynchronization ICD 65%] were enrolled. We collected and evaluated device therapies for at least 18 months and recorded survival status for more than 5 years.
Over a median follow-up of 18 months, 54 (39%) patients received at least one ICD intervention, with 28 patients receiving only appropriate ICD therapies, 13 only inappropriate therapies and 13 receiving both therapies. At a mean follow-up of 63±12 months, 30 deaths occurred in 130 patients (23%); for nine patients, we had no survival status information. Death was classified as cardiac in 22 (73%) patients, the most common cause was progressive heart failure. In a Cox proportional regression model, an appropriate ICD therapy was associated with a significant increase in the subsequent risk of death (hazard ratio 3.02, P=0.003).
In patients implanted with ICD or cardiac resynchronization therapy with ICD devices, for primary or secondary sudden cardiac death prevention, appropriate ICD therapy predicts a three-fold greater risk of death.
在接受植入式心脏复律除颤器 (ICD) 治疗的患者中，不到 50%的患者在随访期间接受了设备治疗。我们的研究目的是前瞻性评估适当的 ICD 治疗对因原发性或继发性预防猝死而植入的患者的长期生存的预测作用。
2002 年至 2003 年，连续纳入 139 例患者[平均年龄 66±9 岁，男性 77%，缺血性心脏病 56%，纽约心脏协会功能分级> II (74%)，原发性预防 74%，平均左心室射血分数 30±9%，心脏再同步化 ICD 65%]。我们收集并评估了至少 18 个月的设备治疗，并记录了超过 5 年的生存状态。
在中位随访 18 个月期间，54 例（39%）患者接受了至少一次 ICD 干预，其中 28 例仅接受了适当的 ICD 治疗，13 例仅接受了不适当的治疗，13 例同时接受了两种治疗。在平均随访 63±12 个月时，130 例患者中有 30 例（23%）死亡；9 例患者没有生存状态信息。死亡被分类为心脏性 22 例（73%），最常见的原因是进行性心力衰竭。在 Cox 比例风险回归模型中，适当的 ICD 治疗与随后死亡风险显著增加相关（风险比 3.02，P=0.003）。
在植入 ICD 或心脏再同步化治疗 ICD 设备的患者中，对于原发性或继发性心脏性猝死的预防，适当的 ICD 治疗预示着死亡风险增加三倍。
