Cardiovascular Division, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
Division of Cardiovascular Medicine, Department of Medicine, Ohio State University, Columbus, Ohio.
J Am Coll Cardiol. 2013 Nov 19;62(21):2000-2007. doi: 10.1016/j.jacc.2013.05.086. Epub 2013 Jul 31.
The aim of this study was to describe usage of the wearable cardioverter-defibrillator (WCD) during mandated waiting periods following myocardial infarction (MI) for patients perceived to be at high risk for sudden cardiac arrest (SCA).
Current device guidelines and insurance coverage require waiting periods of either 40 days or 3 months before implanting a cardioverter-defibrillator post-myocardial infarction (MI), depending on whether or not acute revascularization was undertaken.
We assessed characteristics of and outcomes for patients who had a WCD prescribed in the first 3 months post-MI. The WCD medical order registry was searched for patients who were coded as having had a "recent MI with ejection fraction ≤35%" or given an International Classification of Diseases, Ninth Revision 410.xx diagnostic code (acute MI), and then matched to device-recorded data.
Between September 2005 and July 2011, 8,453 unique patients (age 62.7 ± 12.7 years, 73% male) matched study criteria. A total of 133 patients (1.6%) received 309 appropriate shocks. Of these patients, 91% were resuscitated from a ventricular arrhythmia. For shocked patients, the left ventricular ejection fraction (LVEF) was ≤30% in 106, 30% to 35% in 17, >36% in 8, and not reported in 2 patients. Of the 38% of patients not revascularized, 84% had a LVEF ≤30%; of the 62% of patients revascularized, 77% had a LVEF ≤30%. The median time from the index MI to WCD therapy was 16 days. Of the treated patients, 75% received treatment in the first month, and 96% within the first 3 months of use. Shock success resulting in survival was 84% in nonrevascularized and 95% in revascularized patients.
During the 40-day and 3-month waiting periods in patients post-MI, the WCD successfully treated SCA in 1.4%, and the risk was highest in the first month of WCD use. The WCD may benefit individual patients selected for high risk of SCA early post-MI.
本研究旨在描述在心肌梗死后（MI）的强制性等待期内，对被认为有发生心源性猝死（SCA）高风险的患者使用体外除颤器（WCD）的情况。
目前的设备指南和保险覆盖范围要求，在植入 MI 后除颤器之前，根据是否进行急性血运重建，等待期为 40 天或 3 个月。
我们评估了在 MI 后 3 个月内首次开处 WCD 的患者的特征和结局。搜索 WCD 医嘱登记处，查找被编码为“近期 MI 左室射血分数≤35%”或被给予国际疾病分类，第 9 修订版 410.xx 诊断代码（急性 MI）的患者，并与设备记录的数据相匹配。
2005 年 9 月至 2011 年 7 月，8453 例符合研究标准的患者（年龄 62.7 ± 12.7 岁，73%为男性）。共有 133 例（1.6%）患者接受了 309 次适当的电击。这些患者中，91%是从室性心律失常中复苏的。在接受电击的患者中，106 例左室射血分数（LVEF）≤30%，17 例 30%至 35%，8 例>LVEF>36%，2 例未报告。在未血运重建的患者中，38%的患者 LVEF≤30%；在血运重建的患者中，62%的患者 LVEF≤30%。从指数 MI 到 WCD 治疗的中位时间为 16 天。在接受治疗的患者中，75%在第一个月接受治疗，96%在使用的前 3 个月内接受治疗。未血运重建患者的电击成功生存率为 84%，血运重建患者的电击成功生存率为 95%。
在 MI 后 40 天和 3 个月的等待期内，WCD 在 1.4%的患者中成功治疗了 SCA，并且在 WCD 使用的第一个月风险最高。WCD 可能使 MI 后早期选择的高 SCA 风险的个别患者受益。
