Stavrakis Stavros, Asad Zain, Reynolds Dwight
Department of Medicine, Cardiovascular Section, Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA.
J Cardiovasc Electrophysiol. 2017 Jun;28(6):659-665. doi: 10.1111/jce.13204. Epub 2017 Apr 18.
Implantable cardioverter defibrillators (ICDs) improve survival in patients with heart failure due to ischemic cardiomyopathy, but their benefit in nonischemic cardiomyopathy (NICM) has been recently questioned. We performed a meta-analysis of randomized clinical trials to examine the effect of ICDs on total mortality and arrhythmic death in patients with NICM. We also examined the impact of age and cardiac resynchronization therapy (CRT) on the relative effect of ICD compared to control.
We searched the MEDLINE and EMBASE databases for randomized trials evaluating the effect of ICD versus control in patients with NICM. Hazard ratios (HR) with 95% confidence interval (CI) were calculated using a random effects model. Six trials involving 2,967 patients were included (ICD, n = 1,553; control, n = 1,414). Based on the pooled estimate across the six studies, the use of ICD was associated with a significant reduction in total mortality (HR = 0.78, 95% CI 0.66-0.92; P = 0.003), as well as arrhythmic death (HR = 0.46, 95% CI 0.29-0.71; P = 0.0005) compared to control. ICD decreased total mortality in younger patients compared to control (HR = 0.63, 95% CI 0.46-0.86; P = 0.004), but not in older patients (HR = 0.97, 95% CI 0.56-1.68; P = 0.92). In patients with CRT, ICD reduced total mortality compared to control (HR = 0.78, 95% CI 0.65-0.95; P = 0.02), but not in patients with CRT (HR = 0.71, 95% CI 0.40-1.26).
ICDs decrease total mortality and arrhythmic deaths in patients with NICM. The benefit of ICD appears to be dependent on age and concomitant use of CRT.
植入式心脏复律除颤器（ICD）可提高缺血性心肌病所致心力衰竭患者的生存率，但最近其在非缺血性心肌病（NICM）中的获益受到质疑。我们进行了一项随机临床试验的荟萃分析，以研究ICD对NICM患者总死亡率和心律失常性死亡的影响。我们还研究了年龄和心脏再同步治疗（CRT）对ICD与对照组相比的相对疗效的影响。
我们在MEDLINE和EMBASE数据库中检索了评估ICD与对照组对NICM患者疗效的随机试验。采用随机效应模型计算95%置信区间（CI）的风险比（HR）。纳入了6项涉及2967例患者的试验（ICD组，n = 1553；对照组，n = 1414）。基于六项研究的汇总估计，与对照组相比，使用ICD可显著降低总死亡率（HR = 0.78，95% CI 0.66 - 0.92；P = 0.003）以及心律失常性死亡（HR = 0.46，95% CI 0.29 - 0.71；P = 0.0005）。与对照组相比，ICD可降低年轻患者的总死亡率（HR = 0.63，95% CI 0.46 - 0.86；P = 0.004），但对老年患者无此作用（HR = 0.97，95% CI 0.56 - 1.68；P = 0.92）。在接受CRT的患者中，与对照组相比，ICD可降低总死亡率（HR = 0.78，95% CI 0.65 - 0.95；P = 0.02），但在未接受CRT的患者中无此作用（HR = 0.71，95% CI 0.40 - 1.26）。
ICD可降低NICM患者的总死亡率和心律失常性死亡。ICD的获益似乎取决于年龄和CRT的联合使用情况。
