用于非缺血性心肌病患者一级预防的植入式心脏复律除颤器：一项系统评价和荟萃分析。

Implantable cardioverter defibrillators for primary prevention in patients with nonischemic cardiomyopathy: A systematic review and meta-analysis.

作者信息

Akel Tamer, Lafferty James

机构信息

Department of Internal Medicine, Staten Island University Hospital, Staten Island, NY, USA.

Department of Cardiology, Staten Island University Hospital, Staten Island, NY, USA.

出版信息

Cardiovasc Ther. 2017 Jun;35(3). doi: 10.1111/1755-5922.12253.

DOI:10.1111/1755-5922.12253

PMID:28129469

Abstract

BACKGROUND

Implantable cardioverter defibrillators (ICDs) have proved their favorable outcomes on survival in selected patients with cardiomyopathy. Although previous meta-analyses have shown benefit for their use in primary prevention, the evidence remains less robust for patients with nonischemic cardiomyopathy (NICM) in comparison to patients with coronary artery disease (CAD).

OBJECTIVES

To evaluate the effect of ICD therapy on reducing all-cause mortality and sudden cardiac death (SCD) in patients with NICM.

DATA SOURCES

PubMed (1993-2016), the Cochrane Central Register of Controlled Trials (2000-2016), reference lists of relevant articles, and previous meta-analyses. Search terms included defibrillator, heart failure, cardiomyopathy, randomized controlled trials, and clinical trials.

STUDY SELECTION

Eligible trials were randomized controlled trials with at least an arm of ICD, an arm of medical therapy and enrolled some patients with NICM. The primary endpoint in the trials should include all-cause mortality or mortality from SCD.

DATA EXTRACTION

Hazard ratios (HRs) for all-cause mortality and mortality from SCD were either extracted or calculated along with their standard errors.

DATA SYNTHESIS

Of the 1047 abstracts retained by the initial screen, eight randomized controlled trials were identified. Five of these trials reported relevant data regarding patients with NICM and were subsequently included in this meta-analysis. Pooled analysis of HRs suggested a statistically significant reduction in all-cause mortality among a total of 2573 patients randomized to ICD vs medical therapy (HR 0.80; 95% CI, 0.67-0.96; P=.02). Pooled analysis of HRs for mortality from SCD was also statistically significant (n=1677) (HR 0.51; 95% CI, 0.34-0.76; P=.001).

CONCLUSION

ICD implantation is beneficial in terms of all-cause mortality and mortality from SCD in certain subgroups of patients with NICM.

摘要

背景

植入式心脏复律除颤器（ICD）已在特定心肌病患者的生存方面显示出良好效果。尽管先前的荟萃分析表明其在一级预防中使用有益，但与冠状动脉疾病（CAD）患者相比，非缺血性心肌病（NICM）患者使用ICD的证据仍不那么充分。

目的

评估ICD治疗对降低NICM患者全因死亡率和心源性猝死（SCD）的效果。

数据来源

PubMed（1993 - 2016年）、Cochrane对照试验中心注册库（2000 - 2016年）、相关文章的参考文献列表以及先前的荟萃分析。检索词包括除颤器、心力衰竭、心肌病、随机对照试验和临床试验。

研究选择

符合条件的试验为随机对照试验，至少有一组接受ICD治疗，一组接受药物治疗，且纳入了一些NICM患者。试验的主要终点应包括全因死亡率或SCD死亡率。

数据提取

提取或计算全因死亡率和SCD死亡率的风险比（HR）及其标准误。

数据合成

在初步筛选保留的1047篇摘要中，确定了8项随机对照试验。其中5项试验报告了有关NICM患者的相关数据，随后被纳入该荟萃分析。对HR的汇总分析表明，在总共2573例随机接受ICD治疗与药物治疗的患者中，全因死亡率有统计学意义的降低（HR 0.80；95%CI，0.67 - 0.96；P = 0.02）。对SCD死亡率的HR汇总分析也具有统计学意义（n = 1677）（HR 0.51；95%CI，0.34 - 0.76；P = 0.001）。