COPD 增加了伴有室性心律失常和心搏骤停的患者的心脏死亡率。

COPD increases cardiac mortality in patients presenting with ventricular tachyarrhythmias and aborted cardiac arrest.

机构信息

First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, European Center for AngioScience (ECAS), DZHK (German Center for Cardiovascular Research) Partner Site Heidelberg/Mannheim, Mannheim, Germany.

出版信息

Respir Med. 2018 Dec;145:153-160. doi: 10.1016/j.rmed.2018.10.019. Epub 2018 Oct 24.

DOI:10.1016/j.rmed.2018.10.019

PMID:30509705

Abstract

OBJECTIVES

The study sought to assess the prognostic impact of COPD in patients presenting with ventricular tachyarrhythmias and sudden cardiac arrest (SCA) on admission.

BACKGROUND

Data regarding the outcome of patients with COPD presenting with ventricular tachyarrhythmias and SCA is limited.

METHODS

A large retrospective registry was used including all consecutive patients presenting with ventricular tachycardia (VT), fibrillation (VF) and SCA from 2002 to 2016. Patients with COPD were compared to patients without COPD applying multivariable Cox regression models and propensity-score matching for evaluation of the primary prognostic endpoint defined as long-term all-cause mortality at 2 years. Secondary endpoints were all-cause mortality at index, at 30 days and after discharge, cardiac death at 24 h, rehospitalization related to cardiac causes and the composite endpoint of cardiac death at 24 h, recurrences of ventricular tachyarrhythmias and appropriate ICD therapies at 2 years.

RESULTS

In 2813 unmatched high-risk patients with ventricular tachyarrhythmias and SCA, COPD was present in 9%. VF was less common in COPD (28% versus 39%; p = 0.001). Multivariable Cox regression models revealed that COPD was associated with the primary endpoint of long-term all-cause mortality (HR = 1.245; 95% CI 1.001-1.549; p = 0.001), which was also proven after propensity score matching (log rank p = 0.001). The secondary endpoints of all-cause mortality at index, at 30 days, after discharge, cardiac death at 24 h, as well as the composite endpoint of cardiac death at 24 h, recurrences of ventricular tachyarrhythmias and appropriate ICD therapies were higher in COPD (p < 0.033).

CONCLUSION

In high-risk patients presenting with ventricular tachyarrhythmias and SCA, COPD was associated with higher long-term all-cause mortality, cardiac death at 24 h and higher rates of the composite endpoint of cardiac death at 24 h, recurrences of ventricular tachyarrhythmias and appropriate ICD therapies at 2 years.

摘要

目的

本研究旨在评估入院时患有慢性阻塞性肺疾病（COPD）的患者发生室性心动过速（VT）、心室颤动（VF）和心搏骤停（SCA）的预后影响。

背景

目前有关 COPD 患者发生 VT 和 SCA 后结局的数据有限。

方法

本研究使用了一个大型回顾性登记研究，其中包括了 2002 年至 2016 年期间所有因 VT、VF 和 SCA 而就诊的连续患者。将 COPD 患者与无 COPD 患者进行比较，采用多变量 Cox 回归模型和倾向评分匹配评估主要预后终点，该终点定义为 2 年时的全因死亡率。次要终点包括指数时、30 天时和出院后的全因死亡率、24 小时内的心脏性死亡、与心脏相关的再住院率以及 24 小时内心脏性死亡、VT 复发和合适的 ICD 治疗的复合终点。

结果

在 2813 例未经匹配的高危 VT 和 SCA 患者中，9%患有 COPD。COPD 患者中 VF 较少见（28%对 39%；p=0.001）。多变量 Cox 回归模型显示，COPD 与长期全因死亡率的主要终点相关（HR=1.245；95%CI 1.001-1.549；p=0.001），在进行倾向评分匹配后也得到了证实（对数秩检验 p=0.001）。COPD 患者的指数时、30 天时、出院后的全因死亡率、24 小时内的心脏性死亡，以及 24 小时内心脏性死亡、VT 复发和合适的 ICD 治疗的复合终点的次要终点均较高（p<0.033）。