Department of Cardiology, University Hospital, Basel, Switzerland.
Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands.
Cardiol J. 2019;26(6):711-716. doi: 10.5603/CJ.a2018.0144. Epub 2018 Nov 28.
Guidelines of heart failure therapy include cardiac resynchronization as standard of care in patients with severely depressed left ventricular function and wide QRS complex. It has been shown that patients benefit regarding mortality and morbidity. However, early mortality precludes longterm benefits from the device. The aim of the study was to identify predictors for early occurrence of both death and first-ever implantable cardioverter-defibrillator (ICD) therapy using a large combined database of patients with cardiac resynchronization therapy with defibrillator (CRT-D).
From two registries (tertiary care centers) 904 patients were identified, no single patient was excluded. Early death was defined as death occurring within the 3 years after implantation whereas early ICD therapy as such occurring within the first year. 33 baseline parameters were compared using uni- and multivariate analysis with the Cox model and binary logistic regression.
The population was predominantly male (77%), with mean age of 63 ± 11 years and primary prevention indication in 80%. Mean follow-up was 55 ± 38 months. 256 (28%) patients had ICD therapies whereof the first-ever event occurred early in 52%. 270 (30%) patients died after 41 ± ± 31 months, mostly from advancing heart failure (41%), 141 (52%) patients of them early. Independent predictors for early ICD therapy were secondary prevention and renal failure. Independent predictors for early mortality were a history of percutaneous coronary intervention and of peripheral vascular disease.
Predictors for early mortality after CRT-D implantation were a history of percutaneous coronary intervention and peripheral vascular disease, present in only a minority of patients, thus limiting their use in clinical practice.
心力衰竭治疗指南包括心脏再同步作为严重左心室功能障碍和宽 QRS 复合物患者的标准治疗方法。已经证明，患者在死亡率和发病率方面都受益。然而，早期死亡率排除了设备的长期益处。本研究的目的是使用心脏再同步治疗除颤器（CRT-D）的大型联合患者数据库，确定早期发生死亡和首次植入式心脏复律除颤器（ICD）治疗的预测因素。
从两个注册中心（三级护理中心）确定了 904 名患者，没有排除单个患者。早期死亡定义为植入后 3 年内死亡，而早期 ICD 治疗则在第一年发生。使用 Cox 模型和二项逻辑回归对 33 个基线参数进行单变量和多变量分析。
该人群主要为男性（77%），平均年龄为 63 ± 11 岁，一级预防指征为 80%。平均随访时间为 55 ± 38 个月。256 名（28%）患者接受了 ICD 治疗，其中首次事件发生在 52%的早期。41 ± ± 31 个月后，270 名（30%）患者死亡，主要死于心力衰竭进展（41%），其中 141 名（52%）患者死亡较早。早期 ICD 治疗的独立预测因素是二级预防和肾功能衰竭。早期死亡率的独立预测因素是经皮冠状动脉介入治疗和外周血管疾病的病史。
CRT-D 植入后早期死亡的预测因素是经皮冠状动脉介入治疗和外周血管疾病的病史，这些因素仅存在于少数患者中，因此限制了它们在临床实践中的应用。
