Cardiovascular Division, University Hospital Zurich, Raemistrasse 100, Zürich CH-8091, Switzerland.
Heart. 2013 Aug;99(16):1158-65. doi: 10.1136/heartjnl-2013-304185. Epub 2013 Jun 27.
This study was designed to delineate the role of implantable cardioverter defibrillator (ICD) therapy for the primary and secondary prevention of sudden cardiac death in patients listed for heart transplantation.
Retrospective observational multicentre study.
1089 consecutive patients listed for heart transplantation in two tertiary heart transplant centres were enrolled. Of 550 patients (51%) on the transplant list with an ICD, 216 had received their ICD for the primary prevention of sudden cardiac death and 334 for secondary prevention. 539 patients did not receive an ICD.
Treatment with or without an ICD was left to the discretion of the heart failure specialist.
All-cause mortality.
ICDs appear to be associated with a reduction in all-cause mortality in patients implanted with the device for primary and secondary prevention compared to those without an ICD despite a median time on the waiting list of only 8 months (estimated 1-year: 88±3% vs. 77±3% vs. 67±3%; p=0.0001). A Cox regressional hazard model (corrected for age, sex, underlying heart disease, atrial fibrillation, cardiac resynchronisation therapy, New York Heart Association (NYHA) class, ejection fraction, co-medication and year of listing) suggested an independent beneficial effect of ICDs that was most pronounced in patients who had received an ICD for primary prevention (HR 0.4, 95% CI 0.19 to 0.85; p=0.016).
ICD implantation appears to be associated with an immediate and sustained survival benefit for patients awaiting heart transplantation.
本研究旨在阐明植入式心脏复律除颤器（ICD）治疗在因心脏移植而接受治疗的患者中的一级和二级预防中的作用。
回顾性观察性多中心研究。
在两个三级心脏移植中心接受心脏移植的 1089 例连续患者入选。在 550 例（51%）在移植名单上的 ICD 患者中，216 例因心脏性猝死的一级预防而接受 ICD，334 例因二级预防而接受 ICD。539 例患者未接受 ICD。
是否使用 ICD 治疗由心力衰竭专家决定。
全因死亡率。
尽管在等待名单上的中位数仅为 8 个月（估计 1 年：88±3%比 77±3%比 67±3%；p=0.0001），但与未接受 ICD 治疗的患者相比，植入 ICD 进行一级和二级预防的患者的全因死亡率似乎有所降低。Cox 回归风险模型（校正年龄、性别、基础心脏病、心房颤动、心脏再同步治疗、纽约心脏协会（NYHA）分级、射血分数、合并用药和列表年份）表明 ICD 具有独立的有益作用，这在因一级预防而接受 ICD 的患者中最为明显（HR 0.4，95%CI 0.19 至 0.85；p=0.016）。
ICD 植入似乎与等待心脏移植的患者立即和持续的生存获益相关。
