Cardiovascular Division, Veterans Affairs Medical Center, Minneapolis, Minnesota; Cardiovascular Division, University of Minnesota Medical School, Minneapolis, Minnesota.
Cardiovascular Division, University of Minnesota Medical School, Minneapolis, Minnesota.
JACC Clin Electrophysiol. 2017 Jan;3(1):33-40. doi: 10.1016/j.jacep.2016.07.010. Epub 2016 Sep 14.
This study sought to assess the impact of implantable cardioverter-defibrillators (ICDs) on waitlist mortality in patients listed for heart transplantation (HT).
The impact of ICDs on preventing sudden cardiac death in patients awaiting HT has not been studied in large multicenter cohorts. Furthermore, whether ICDs benefit patients with a left ventricular assist device (LVAD) is unknown.
Adults (age ≥18 years) listed for first-time HT in the United States between January 1, 1999, and September 30, 2014, were retrospectively identified from the United Network for Organ Sharing registry. The primary predictor variable was the presence of an ICD at the time of listing. Primary outcome variable was all-cause waitlist mortality.
Data on 32,599 patients (mean age 53 ± 12 years, 77% male, 70% Caucasian) were analyzed. During median follow-up of 154 days, 3,638 patients (11%) died on the waitlist (9% in ICD group vs. 15% in no-ICD group; p < 0.0001), whereas 63% underwent HT. Having an ICD at listing was associated with an adjusted 13% relative reduction in mortality (hazard ratio: 0.87; 95% confidence interval: 0.80 to 0.94). In the subgroup of patients with LVAD (n = 9,478), having an ICD was associated with an adjusted 19% relative reduction in mortality (hazard ratio: 0.81; 95% confidence interval: 0.70 to 0.94).
ICD use was associated with improved survival on the HT waitlist in patients with or without LVADs. These findings strengthen the current guideline recommendations of using ICDs in nonhospitalized patients awaiting HT and provide new insight into the effectiveness of ICDs on survival in LVAD-supported patients.
本研究旨在评估植入式心脏复律除颤器（ICD）对心脏移植（HT）候补患者等待名单死亡率的影响。
ICD 在预防等待 HT 的患者心源性猝死方面的影响尚未在大型多中心队列中进行研究。此外，ICD 是否有益于左心室辅助装置（LVAD）患者尚不清楚。
在美国，1999 年 1 月 1 日至 2014 年 9 月 30 日期间，回顾性地从器官共享联合网络登记处确定首次接受 HT 的成年人（年龄≥18 岁）。主要预测变量是在列入名单时是否存在 ICD。主要结局变量是全因等待名单死亡率。
共分析了 32599 例患者（平均年龄 53±12 岁，77%为男性，70%为白种人）的数据。在中位随访 154 天期间，3638 例患者（11%）在等待名单上死亡（ICD 组为 9%，无 ICD 组为 15%；p<0.0001），而 63%的患者接受了 HT。列入名单时存在 ICD 与死亡率相对降低 13%相关（风险比：0.87；95%置信区间：0.80 至 0.94）。在有 LVAD 的患者亚组（n=9478）中，存在 ICD 与死亡率相对降低 19%相关（风险比：0.81；95%置信区间：0.70 至 0.94）。
在有或没有 LVAD 的 HT 候补患者中，ICD 的使用与等待名单上的生存率提高相关。这些发现加强了当前指南建议在非住院等待 HT 的患者中使用 ICD 的建议，并为 ICD 在 LVAD 支持的患者的生存中有效性提供了新的见解。
