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他汀类药物对轻度心力衰竭患者首次及复发性室上性心律失常的影响(来自心脏再同步治疗的多中心自动除颤器植入试验)

Effects of Statins on First and Recurrent Supraventricular Arrhythmias in Patients With Mild Heart Failure (from the Multicenter Automatic Defibrillator Implantation Trial With Cardiac Resynchronization Therapy).

作者信息

Biton Yitschak, Goldenberg Ilan, Kutyifa Valentina, Zareba Wojciech, Szepietowska Barbara, Mcnitt Scott, Polonsky Bronislava, Barsheshet Alon, Moss Arthur J

机构信息

Heart Research Follow-up Program, Division of Cardiology, Department of Medicine, University of Rochester Medical Center, Rochester, New York; Heart Institute, Cardiology Department, Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.

Heart Research Follow-up Program, Division of Cardiology, Department of Medicine, University of Rochester Medical Center, Rochester, New York; Heart Institute, Cardiology Department, Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.

出版信息

Am J Cardiol. 2015 Dec 15;116(12):1869-74. doi: 10.1016/j.amjcard.2015.09.027. Epub 2015 Oct 8.


DOI:10.1016/j.amjcard.2015.09.027
PMID:26508711
Abstract

Previous studies suggested that statin therapy reduces the risk of occurrence and recurrence of atrial fibrillation mainly in patients with coronary artery disease. Data regarding the effect of statins on the risk for the entire range of supraventricular arrhythmias (SVA) in mild heart failure (HF) with different disease causes are lacking. Multivariate Cox proportional hazards regression models were used to assess the effect of statin therapy, evaluated as a time-dependent covariate, on the risk of SVA and recurrent SVA (defined as atrial fibrillation, atrial flutter, atrial tachycardia, and supraventricular tachycardia) that were inappropriately treated with implantable cardioverter-defibrillator device in 1,790 patients enrolled in the Multicenter Automatic Defibrillator Implantation With Cardiac Resynchronization Therapy trial. Statin users constituted 68% of the study patients (n = 1209). They were older and more frequently men; they were more likely to have ischemic cardiomyopathy, diabetes, hypertension, and previous atrial arrhythmias. During the 3.7-year median follow-up time, 160 patients had an SVA event, and the total number of recurrent events was 335. Time-dependent statin therapy was independently associated with a significant 29% reduction of the first SVA event (p = 0.046) and 33% reduction of recurrent SVA events (p = 0.003), consistent across all prespecified subgroups. In conclusion, in mild HF with either cardiac resynchronization therapy with a defibrillator or an implantable cardioverter-defibrillator device, statin therapy was associated with significant reduction of occurrence and recurrence of inappropriately treated SVA.

摘要

先前的研究表明,他汀类药物治疗主要在冠心病患者中降低房颤发生和复发的风险。关于他汀类药物对不同病因的轻度心力衰竭(HF)患者整个室上性心律失常(SVA)范围风险影响的数据尚缺乏。在多中心自动除颤器植入与心脏再同步治疗试验纳入的1790例患者中,使用多变量Cox比例风险回归模型评估作为时间依赖性协变量的他汀类药物治疗对SVA和复发性SVA(定义为房颤、房扑、房性心动过速和室上性心动过速)风险的影响,这些SVA经植入式心律转复除颤器装置治疗不当。他汀类药物使用者占研究患者的68%(n = 1209)。他们年龄更大,男性更常见;更有可能患有缺血性心肌病、糖尿病、高血压和既往房性心律失常。在3.7年的中位随访时间内,160例患者发生了SVA事件,复发事件总数为335次。时间依赖性他汀类药物治疗与首次SVA事件显著降低29%(p = 0.046)和复发性SVA事件降低33%(p = 0.003)独立相关,在所有预先指定的亚组中均一致。总之,在接受心脏再同步治疗除颤器或植入式心律转复除颤器装置的轻度HF患者中,他汀类药物治疗与不当治疗的SVA发生和复发显著降低相关。

相似文献

[1]
Effects of Statins on First and Recurrent Supraventricular Arrhythmias in Patients With Mild Heart Failure (from the Multicenter Automatic Defibrillator Implantation Trial With Cardiac Resynchronization Therapy).

Am J Cardiol. 2015-12-15

[2]
Reduction in life-threatening ventricular tachyarrhythmias in statin-treated patients with nonischemic cardiomyopathy enrolled in the MADIT-CRT (Multicenter Automatic Defibrillator Implantation Trial with Cardiac Resynchronization Therapy).

J Am Coll Cardiol. 2012-6-13

[3]
Cardiac resynchronization therapy reduces left atrial volume and the risk of atrial tachyarrhythmias in MADIT-CRT (Multicenter Automatic Defibrillator Implantation Trial with Cardiac Resynchronization Therapy).

J Am Coll Cardiol. 2011-10-11

[4]
Inverse Relationship of Blood Pressure to Long-Term Outcomes and Benefit of Cardiac Resynchronization Therapy in Patients With Mild Heart Failure: A Multicenter Automatic Defibrillator Implantation Trial With Cardiac Resynchronization Therapy Long-Term Follow-Up Substudy.

Circ Heart Fail. 2015-9

[5]
Temporal Influence of Heart Failure Hospitalizations Prior to Implantable Cardioverter Defibrillator or Cardiac Resynchronization Therapy With Defibrillator on Subsequent Outcome in Mild Heart Failure Patients (from MADIT-CRT).

Am J Cardiol. 2015-5-15

[6]
Impact of carvedilol and metoprolol on inappropriate implantable cardioverter-defibrillator therapy: the MADIT-CRT trial (Multicenter Automatic Defibrillator Implantation With Cardiac Resynchronization Therapy).

J Am Coll Cardiol. 2013-6-13

[7]
Left ventricular ejection fraction normalization in cardiac resynchronization therapy and risk of ventricular arrhythmias and clinical outcomes: results from the Multicenter Automatic Defibrillator Implantation Trial With Cardiac Resynchronization Therapy (MADIT-CRT) trial.

Circulation. 2014-10-9

[8]
Cardiac resynchronization therapy reduces the risk of cardiac events in patients with diabetes enrolled in the multicenter automatic defibrillator implantation trial with cardiac resynchronization therapy (MADIT-CRT).

Circ Heart Fail. 2011-2-24

[9]
Comparison of age (<75 Years versus ≥75 Years) to risk of ventricular tachyarrhythmias and implantable cardioverter defibrillator shocks (from the Multicenter Automatic Defibrillator Implantation Trial With Cardiac Resynchronization Therapy).

Am J Cardiol. 2014-12-15

[10]
Predictors of super-response to cardiac resynchronization therapy and associated improvement in clinical outcome: the MADIT-CRT (multicenter automatic defibrillator implantation trial with cardiac resynchronization therapy) study.

J Am Coll Cardiol. 2012-6-19

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