Veterans Administration Palo Alto Healthcare System, Palo Alto, California.
Palo Alto Medical Foundation, Palo Alto, California.
JACC Heart Fail. 2015 Jun;3(6):497-504. doi: 10.1016/j.jchf.2015.01.012. Epub 2015 May 14.
This study sought to describe the use of CRT-D and its association with survival for older patients.
Many patients who receive cardiac resynchronization therapy with defibrillator (CRT-D) in practice are older than those included in clinical trials.
We identified patients undergoing ICD implantation in the National Cardiovascular Disease Registry (NCDR) ICD registry from 2006 to 2009, who also met clinical trial criteria for CRT, including left ventricular ejection fraction (LVEF) ≤35%, QRS ≥120 ms, and New York Heart Association (NYHA) functional class III or IV. NCDR registry data were linked to the social security death index to determine the primary outcome of time to death from any cause. We identified 70,854 patients from 1,187 facilities who met prior trial criteria for CRT-D. The mean age of the 58,147 patients receiving CRT-D was 69.4 years with 6.4% of patients age 85 or older. CRT use was 80% or higher among candidates in all age groups. Follow-up was available for 42,285 patients age ≥65 years at 12 months.
Receipt of CRT-D was associated with better survival at 1 year (82.1% vs. 77.1%, respectively) and 4 years (54.0% vs. 46.2% , respectively) than in those receiving only an ICD (p < 0.001). The CRT association with improved survival was not different for different age groups (p = 0.86 for interaction).
More than 80% of older patients undergoing ICD implantation who were candidates for a CRT-D received the combined device. Mortality in older patients undergoing ICD implantation was high but was lower for those receiving CRT-D.
本研究旨在描述心脏再同步治疗除颤器（CRT-D）的使用情况及其与患者生存的关系。
在实践中，许多接受心脏再同步治疗除颤器（CRT-D）的患者比临床试验中纳入的患者年龄更大。
我们从 2006 年至 2009 年确定了在全国心血管疾病登记处（NCDR）ICD 登记处接受植入式心脏复律除颤器（ICD）植入的患者，这些患者也符合 CRT 的临床试验标准，包括左心室射血分数（LVEF）≤35%、QRS 波≥120ms 和纽约心脏协会（NYHA）心功能 III 或 IV 级。NCDR 登记处的数据与社会安全死亡索引相关联，以确定任何原因导致的死亡时间这一首要结局。我们从 1187 个中心确定了符合 CRT-D 先前临床试验标准的 70854 名患者。接受 CRT-D 的 58147 名患者的平均年龄为 69.4 岁，其中 6.4%的患者年龄在 85 岁或以上。在所有年龄组中，符合 CRT-D 条件的患者中，有 80%或以上的患者接受了 CRT-D。在≥65 岁的 42285 名患者中，12 个月时可获得随访。
与仅接受 ICD 治疗的患者相比，接受 CRT-D 治疗的患者在 1 年（分别为 82.1%和 77.1%）和 4 年（分别为 54.0%和 46.2%）时的生存率更高（p<0.001）。不同年龄组 CRT-D 与改善生存率的相关性无差异（p=0.86，交互作用）。
在接受 ICD 植入的老年患者中，超过 80%的符合 CRT-D 条件的患者接受了联合设备治疗。接受 ICD 植入的老年患者死亡率较高，但接受 CRT-D 治疗的患者死亡率较低。
