Heart Institute, Sheba Medical Center, Ramat Gan, Israel.
Am J Cardiol. 2013 Dec 15;112(12):1896-900. doi: 10.1016/j.amjcard.2013.08.016. Epub 2013 Sep 25.
There are limited data regarding risk factors for the development of ischemic events (IEs) among patients with ischemic cardiomyopathy (IC) who receive cardiac resynchronization therapy with a defibrillator (CRT-D) and their effect on the efficacy of the device. The present study population comprised 1,045 patients with IC enrolled in the Multicenter Automatic Defibrillator Implantation Trial-Cardiac Resynchronization Therapy. We used multivariate Cox proportional hazards regression modeling to identify risk factors for the development of IE (comprising hospitalization for acute coronary syndromes and/or coronary interventions during the trial) among study patients. Time-dependent analysis was performed to identify the effect of IE on the risk for subsequent heart failure (HF) or death in CRT-D recipients. Independent predictors for the development of IE among study patients included previous revascularization (coronary artery bypass surgery: hazard ratio [HR] 1.88, p = 0.003; percutaneous coronary intervention: HR 3.21, p <0.001) and increased systolic blood pressure (HR 1.67, p = 0.02), whereas a left bundle branch block pattern on the baseline electrocardiogram was associated with reduced risk for IE (HR 0.62, p = 0.02). Treatment with CRT-D did not have a significant effect on IE risk compared with defibrillator-only therapy (HR 0.87, p = 0.51). Time-dependent analysis showed that the development of IEs among CRT-D recipients was associated with more than twofold (p = 0.01) increased risk for subsequent heart failure or death. In conclusion, our data suggest that treatment with CRT-D does not reduce the risk of IE in patients with IC and that the benefit of CRT-D is attenuated after the development of IEs in this population.
在接受心脏再同步治疗除颤器（CRT-D）治疗的缺血性心肌病（IC）患者中，关于缺血事件（IE）发展的危险因素的数据有限，以及这些危险因素对设备疗效的影响。本研究人群包括在多中心自动除颤器植入试验-心脏再同步治疗中纳入的 1045 例 IC 患者。我们使用多变量 Cox 比例风险回归模型来确定研究患者中 IE（包括急性冠状动脉综合征住院和/或试验期间的冠状动脉介入治疗）发展的危险因素。进行时间依赖性分析以确定 IE 对 CRT-D 接受者随后心力衰竭（HF）或死亡风险的影响。研究患者中 IE 发展的独立预测因素包括先前的血运重建（冠状动脉旁路移植术：风险比 [HR] 1.88，p = 0.003；经皮冠状动脉介入治疗：HR 3.21，p <0.001）和收缩压升高（HR 1.67，p = 0.02），而基线心电图上存在左束支传导阻滞模式与 IE 风险降低相关（HR 0.62，p = 0.02）。与单独除颤器治疗相比，CRT-D 治疗并未显著影响 IE 风险（HR 0.87，p = 0.51）。时间依赖性分析显示，在 CRT-D 接受者中发生 IE 与随后 HF 或死亡的风险增加两倍以上（p = 0.01）相关。总之，我们的数据表明，在 IC 患者中，CRT-D 治疗并不能降低 IE 的风险，并且在该人群中发生 IE 后，CRT-D 的益处会减弱。
