Romero Jorge, Chaudhary Rahul, Garg Jalaj, Lupercio Florentino, Shah Neeraj, Gupta Rahul, Nazir Talha, Bozorgnia Babak, Natale Andrea, Di Biase Luigi
Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY, 10467, USA.
Department of Medicine, Sinai Hospital of Baltimore, Johns Hopkins University, Baltimore, MD, USA.
J Interv Card Electrophysiol. 2017 Sep;49(3):263-270. doi: 10.1007/s10840-017-0260-8. Epub 2017 Jul 3.
A mortality benefit in patients with implantable cardioverter defibrillator (ICD) in ischemic cardiomyopathy is well established. However, the benefit of ICD implantation in non-ischemic cardiomyopathy (NICM) on total mortality remains uncertain. We performed a systematic review and meta-analysis of randomized controlled trials (RCT) evaluating the role of primary prevention ICD in NICM patients.
We performed a systematic review on PubMed, The Cochrane Library, EMBASE, EBSCO, Web of Science, and CINAHL databases from the inception through February 2017 to identify RCT evaluating the role of ICD in NICM patients. Mantel-Haenszel risk ratio (RR) fixed effects model was used to summarize data across treatment arms. If heterogeneity (I ) ≥25, random effects model was used instead.
We analyzed a total of 2573 patients from five RCTs comparing ICD with medical therapy in patients with NICM. The mean follow up for the trials was 48 ± 22 months. There was a significant reduction in (a) all-cause mortality (RR 0.84, 95% CI 0.71-0.99, p = 0.03) and (b) sudden cardiac death (RR 0.47, 95% CI 0.30-0.73, p < 0.001) in ICD group versus medical therapy.
Our analysis demonstrates that the use of ICD for primary prevention is associated with a reduction in all-cause mortality and SCD in patients with NICM.
植入式心脏复律除颤器（ICD）对缺血性心肌病患者的死亡率有益，这一点已得到充分证实。然而，ICD植入对非缺血性心肌病（NICM）患者总死亡率的益处仍不确定。我们对评估ICD在NICM患者中一级预防作用的随机对照试验（RCT）进行了系统评价和荟萃分析。
我们对PubMed、Cochrane图书馆、EMBASE、EBSCO、科学网和CINAHL数据库进行了系统评价，时间从建库至2017年2月，以确定评估ICD在NICM患者中作用的RCT。采用Mantel-Haenszel风险比（RR）固定效应模型汇总各治疗组的数据。如果异质性（I）≥25，则改用随机效应模型。
我们分析了五项RCT中的2573例患者，这些试验比较了ICD与药物治疗在NICM患者中的效果。试验的平均随访时间为48±22个月。与药物治疗相比，ICD组在（a）全因死亡率（RR 0.84，95%CI 0.71-0.99，p=0.03）和（b）心源性猝死（RR 0.47，95%CI 0.30-0.73，p<0.001）方面有显著降低。
我们的分析表明，ICD用于一级预防可降低NICM患者的全因死亡率和心源性猝死。
