González-Torrecilla Esteban, Arenal Angel, Atienza Felipe, Datino Tomas, Eidelman Gabriel, Miracle Angel, Hernández Jesus, Avila Pablo, Fernández-Avilés Francisco
Cardiology Department, Hospital General Universitario "Gregorio Marañón", Madrid Spain.
Rev Recent Clin Trials. 2012 Aug;7(3):197-203. doi: 10.2174/157488712802281385.
Although clinical trials evaluating therapy with implantable cardioverter defibrillators (ICD) have had clear limitations, there are few interventions in which multiple trial settings over a long period have consistently produced a 20% to 30% reduction in total mortality in patients with left ventricular dysfunction. Substantial differences between the Guidelines on ICD implantation have resulted and the number of patients actually implanted following these recommendations remains relatively low. As well as this, different reasons have been proposed to explain why randomized trials of ICD versus control subjects implanted early after myocardial infarction do not show survival benefit. Moreover, many factors in addition to ejection fraction (EF) do influence the prognosis of patients with coronary disease. However, there are few tools to use this information to guide clinical decisions. Recent years have seen an ongoing debate on the further risk stratification of patients who will benefit most from ICD implantation and a combination of a few readily available clinical variables indicating advanced disease and comorbid conditions identifies ICD patients at high risk. In addition, the role of these devices in patients with nonischemic cardiomyopathies, in older patients and females, for prevention of sudden cardiac death (SCD), has long been debated. This review aims to summarize these criticisms and to refine the current indications of ICD implantation in patients with moderate-severe left ventricular dysfunction.
尽管评估植入式心脏复律除颤器（ICD）治疗效果的临床试验存在明显局限性，但在很长一段时间内，很少有干预措施能使左心室功能不全患者的总死亡率持续降低20%至30%。ICD植入指南之间存在显著差异，且按照这些建议实际植入ICD的患者数量仍然相对较少。除此之外，对于心肌梗死后早期植入ICD的患者与对照组进行随机试验为何未显示出生存获益，人们提出了不同的原因。此外，除射血分数（EF）外，还有许多因素会影响冠心病患者的预后。然而，利用这些信息来指导临床决策的工具却很少。近年来，关于哪些患者将从ICD植入中获益最大的进一步风险分层一直存在争议，一些表明疾病进展和合并症的现成临床变量相结合，可识别出高风险的ICD患者。此外，这些装置在非缺血性心肌病患者、老年患者和女性患者中预防心脏性猝死（SCD）的作用，长期以来一直存在争议。本综述旨在总结这些批评意见，并完善目前中重度左心室功能不全患者ICD植入的适应证。
