Leviev Heart Center, Chaim Sheba Medical Center, Tel Hashomer, Israel.
J Am Coll Cardiol. 2012 Aug 21;60(8):749-55. doi: 10.1016/j.jacc.2012.03.041. Epub 2012 Jun 13.
This study hypothesized that time-dependent statin therapy will reduce the risk of life-threatening ventricular tachyarrhythmias among patients with nonischemic cardiomyopathy (NICM) enrolled in the MADIT-CRT (Multicenter Automatic Defibrillator Implantation Trial with Cardiac Resynchronization Therapy).
Prior studies suggested that statin therapy exerts antiarrhythmic properties among patients with coronary artery disease. However, data regarding the effect of statins on arrhythmic risk among patients with NICM are limited.
Multivariate Cox proportional hazards regression modeling was used to assess the effect of statin therapy, evaluated as a time-dependent covariate, on the risk of appropriate defibrillator therapy for fast ventricular tachycardia (VT) (defined as a rate faster than 180 beats/min)/ventricular fibrillation (VF) or death (primary endpoint) and appropriate defibrillator shocks (secondary endpoint) among 821 patients with NICM enrolled in the MADIT-CRT trial.
Statin users (n = 499) were older and had a higher prevalence of diabetes and hypertension yet were less frequently smokers. Multivariate analysis showed that time-dependent statin therapy was independently associated with a significant 77% reduction in the risk of fast VT/VF or death (p < 0.001) and with a significant 46% reduction in the risk of appropriate implantable cardioverter defibrillator shocks (p = 0.01). Consistent with these findings, the cumulative probability of fast VT/VF or death at 4 years of follow-up was significantly lower among patients who were treated with statins (11%) as compared with study patients who were not treated with statins (19%; p = 0.006 for the overall difference during follow-up).
Statin use was associated with a significant reduction in the risk of life-threatening ventricular tachyarrhythmias among patients with NICM.
本研究假设，对于纳入 MADIT-CRT（多中心自动除颤器植入试验与心脏再同步治疗）的非缺血性心肌病（NICM）患者，时间依赖性他汀类药物治疗将降低危及生命的室性心动过速/心室颤动（VT/VF）风险。
先前的研究表明，他汀类药物治疗在冠心病患者中具有抗心律失常作用。然而，关于他汀类药物对 NICM 患者心律失常风险的影响的数据有限。
使用多变量 Cox 比例风险回归模型来评估他汀类药物治疗（作为时间依赖性协变量进行评估）对 821 例 NICM 患者因快速 VT（定义为超过 180 次/分的速率）/VF 或死亡（主要终点）而接受适当除颤器治疗的风险的影响，以及对因适当除颤器电击（次要终点）的风险。
他汀类药物使用者（n=499）年龄较大，且糖尿病和高血压患病率较高，但吸烟率较低。多变量分析表明，时间依赖性他汀类药物治疗与快速 VT/VF 或死亡风险显著降低 77%（p＜0.001）以及适当植入式心脏复律除颤器电击风险显著降低 46%（p=0.01）独立相关。与这些发现一致的是，在 4 年的随访中，接受他汀类药物治疗的患者发生快速 VT/VF 或死亡的累积概率明显低于未接受他汀类药物治疗的研究患者（11%比 19%；p=0.006 为随访期间的总体差异）。
他汀类药物治疗与 NICM 患者发生危及生命的室性心律失常风险显著降低相关。
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