First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, European Center for AngioScience (ECAS) and DZHK (German Center for Cardiovascular Research) partner site Heidelberg/Mannheim, Germany.
First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, European Center for AngioScience (ECAS) and DZHK (German Center for Cardiovascular Research) partner site Heidelberg/Mannheim, Germany.
Int J Cardiol. 2019 Feb 15;277:118-124. doi: 10.1016/j.ijcard.2018.11.030. Epub 2018 Nov 15.
The study sought to assess the prognostic impact of treatment with beta-blocker (BB) compared to combined BB plus amiodarone (BB-AMIO) on long-term survival in patients surviving ventricular tachyarrhythmias on admission.
Data regarding the prognostic outcome of patients presenting with ventricular tachyarrhythmias treated with BB and BB-AMIO is limited.
A large retrospective registry was used including consecutive patients surviving index episodes of ventricular tachyarrhythmias from 2002 to 2016. Patients treated with BB were compared to patients with BB-AMIO. The primary prognostic endpoint was long-term all-cause death at 3 years. Kaplan-Meier, multivariable Cox regression and propensity score matching analyses were applied.
A total of 1354 patients was included, 85% treated with BB, 15% with BB-AMIO. Within the unmatched real-life cohort, uni- and multivariable Cox regression models revealed BB associated with improved long-term survival compared to BB-AMIO (univariable: HR = 0.550; p = 0.001, multivariable: HR = 0.712; statistical trend, p = 0.052). After propensity-score matching (n = 186 matched pairs), BB therapy was still associated with improved survival compared to BB-AMIO (mortality rate 18% versus 26%; log rank p = 0.042; HR = 0.634; 95% CI = 0.407-0.988; p = 0.044). Prognostic superiority of BB was mainly observed in patients with LVEF ≥ 35% (HR = 0.463; 95% CI = 0.215-0.997; p = 0.049) and in those without atrial fibrillation (non-AF) (HR = 0.415; 95% CI = 0.202-0.852; p = 0.017).
BB therapy is associated with improved secondary long-term prognosis compared to BB-AMIO in patients surviving index episodes of ventricular tachyarrhythmias.
本研究旨在评估与β受体阻滞剂（BB）联合胺碘酮（BB-AMIO）相比，在入院时存活的室性心动过速患者中，BB 治疗对长期生存的预后影响。
关于接受 BB 和 BB-AMIO 治疗的出现室性心动过速患者的预后结果的数据有限。
使用大型回顾性登记处，纳入 2002 年至 2016 年期间首次出现室性心动过速的连续患者。将接受 BB 治疗的患者与接受 BB-AMIO 治疗的患者进行比较。主要预后终点是 3 年时的全因死亡。应用 Kaplan-Meier、多变量 Cox 回归和倾向评分匹配分析。
共纳入 1354 例患者，85%接受 BB 治疗，15%接受 BB-AMIO 治疗。在未匹配的真实队列中，单变量和多变量 Cox 回归模型显示 BB 与 BB-AMIO 相比，长期生存改善（单变量：HR=0.550；p=0.001，多变量：HR=0.712；趋势统计学意义，p=0.052）。在倾向评分匹配后（n=186 对匹配），BB 治疗与 BB-AMIO 相比仍与改善的生存相关（死亡率 18%对 26%；对数秩检验 p=0.042；HR=0.634；95%CI=0.407-0.988；p=0.044）。BB 的预后优势主要在 LVEF≥35%的患者中观察到（HR=0.463；95%CI=0.215-0.997；p=0.049）和无房颤（非 AF）的患者中观察到（HR=0.415；95%CI=0.202-0.852；p=0.017）。
与 BB-AMIO 相比，在首次出现室性心动过速的患者中，BB 治疗与改善的二级长期预后相关。
