糖尿病与心力衰竭老年患者心脏再同步化治疗伴植入式心脏复律除颤器治疗的结局
Diabetes Mellitus and Outcomes of Cardiac Resynchronization With Implantable Cardioverter-Defibrillator Therapy in Older Patients With Heart Failure.
机构信息
From the Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (J.B.E.-T.); Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora (F.A.M.); Department of Medicine, Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, CT (H.B., E.S.S.); and Department of Medicine, Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan UCLA Medical Center, University of California, Los Angeles (G.C.F.).
出版信息
Circ Arrhythm Electrophysiol. 2016 Aug;9(8). doi: 10.1161/CIRCEP.116.004132.
BACKGROUND
Large-scale data on outcomes with cardiac resynchronization therapy with defibrillator in patients with diabetes mellitus are limited. We compared outcomes after cardiac resynchronization therapy with defibrillator implantation among patients with heart failure who have diabetes mellitus versus those without diabetes mellitus.
METHODS AND RESULTS
Survival curves and covariate adjusted hazard ratio (HR) or odds ratio were used to assess the risks for death, readmission, and device-related complications by diabetes mellitus status among 18 428 patients at least 65 years old receiving cardiac resynchronization therapy with defibrillator from the National Cardiovascular Data Registry, implantable cardioverter-defibrillator registry between 2006 and 2009, with up to 3 years of follow-up. Accounting for differences between groups, compared with those without diabetes mellitus (n=11 345), patients with diabetes mellitus (n=7083) had a higher risk of death both at 1 year (HR, 1.16 [95% confidence interval (CI), 1.05-1.29]; P=0.0037) and 3 years (HR, 1.21 [1.14-1.29]; P<0.001) after device implantation and higher risks of all-cause readmission (sub-HR, 1.16 [1.11-1.21] at 1 year; P<0.0001; sub-HR, 1.15 [1.11-1.19] at 3 years; P<0.0001) and heart failure-related readmission (sub-HR, 1.18 [1.09-1.28] at 1 year; P<0.0001; and sub-HR, 1.22 [1.15-1.30] at 3 years; P<0.0001). Device-related complications within 90 days did not differ between those with and without diabetes mellitus (odds ratio: 0.90 [0.77-1.06]; P=0.37). Interactions of age, sex, ischemic cardiomyopathy, renal failure, or QRS duration were not significant.
CONCLUSIONS
In older patients with heart failure receiving cardiac resynchronization therapy with defibrillator, diabetes mellitus was independently associated with greater risks of death and rehospitalization, but similar risks of procedural complications.
背景
关于糖尿病患者心脏再同步治疗除颤器的结局的大规模数据有限。我们比较了患有心力衰竭且患有糖尿病与未患有糖尿病的患者心脏再同步治疗除颤器植入后的结局。
方法和结果
在 2006 年至 2009 年期间，国家心血管数据登记处和植入式心脏复律除颤器登记处共 18428 名年龄至少 65 岁的接受心脏再同步治疗除颤器的患者中，使用生存曲线和协变量调整的风险比（HR）或优势比来评估糖尿病患者（n=7083）与无糖尿病患者（n=11345）的死亡率、再入院率和器械相关并发症的风险。考虑到组间差异，与无糖尿病患者相比，糖尿病患者在植入设备后 1 年（HR，1.16 [95%置信区间（CI），1.05-1.29]；P=0.0037）和 3 年（HR，1.21 [1.14-1.29]；P<0.001）时的死亡率风险更高，全因再入院风险更高（亚 HR，1.16 [1.11-1.21]，1 年；P<0.0001；亚 HR，1.15 [1.11-1.19]，3 年；P<0.0001），心力衰竭相关再入院风险更高（亚 HR，1.18 [1.09-1.28]，1 年；P<0.0001；亚 HR，1.22 [1.15-1.30]，3 年；P<0.0001）。但在 90 天内器械相关并发症在糖尿病患者与无糖尿病患者之间没有差异（比值比：0.90 [0.77-1.06]；P=0.37）。年龄、性别、缺血性心肌病、肾衰竭或 QRS 持续时间的交互作用不显著。
结论
在接受心脏再同步治疗除颤器的老年心力衰竭患者中，糖尿病与更高的死亡率和再入院风险独立相关，但与程序并发症的风险相似。
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