Department of Cardiology, Herlev-Gentofte University Hospitals, Kildegårdsvej 28, Copenhagen, Hellerup, Denmark.
Department of Cardiology, Rigshospitalet, Copenhagen, Denmark.
Europace. 2019 Mar 1;21(3):465-474. doi: 10.1093/europace/euy268.
Patients with cancer are insufficiently represented in randomized clinical trials investigating efficacy of implantable cardioverter-defibrillators (ICDs). We aimed to describe outcomes in patients with a pre-existing diagnosis of cancer at time of ICD implantation.
We utilized Danish nationwide registries to identify primary and secondary prevention ICD implantations from 2007 to 2012. Multivariable Cox models were used to assess the risk of appropriate ICD therapy and mortality in patients with and without cancer at time of implantation. During a median follow-up of 2.1 years, 2935 primary prevention ICD and 2730 secondary prevention ICD implantations were identified. Out of these [289 (5.1%)] had pre-existing cancer [primary 140 (4.8%), secondary 149 (5.5%)]. No differential risk for appropriate ICD therapy was found between patients with or without cancer, [primary cancer: 19/140, no cancer: 380/2795, hazard ratio (HR) = 1.07 (0.67-1.69)] and [secondary cancer: 42/149, no cancer: 699/2581, HR = 1.28 (0.93-1.75)]. In primary patients, cancer was not associated with higher risk of 1-year [cancer: 10/140, no cancer: 133/2795, HR = 1.20 (0.84-2.28)] or all-time mortality [cancer: 22/140, no cancer: 339/2795, HR = 1.13 (0.74-1.75)]. In secondary patients, cancer was associated with a higher 1-year [cancer: 19/149, no cancer: 108/2581, HR = 2.62 (1.60-4.29)] and all-time mortality [cancer: 44/149, no cancer: 315/2581, HR = 2.36 (1.71-3.24)].
Implantable cardioverter-defibrillators were implanted in a minority of cancer patients. No difference in risk of appropriate therapy was observed between cancer and non-cancer patients, regardless of implant indication. Cancer was associated with increased mortality in secondary prevention ICD patients, but not in primary prevention ICD patients. In secondary prevention ICD patients, the majority of deaths were attributable to cancer.
在研究植入式心脏复律除颤器（ICD）疗效的随机临床试验中，癌症患者的代表性不足。本研究旨在描述在 ICD 植入时患有预先存在的癌症诊断的患者的结局。
我们利用丹麦全国性登记处，从 2007 年至 2012 年确定了原发性和继发性预防 ICD 植入。多变量 Cox 模型用于评估植入时患有和不患有癌症的患者的适当 ICD 治疗和死亡率的风险。在中位随访 2.1 年后，确定了 2935 例原发性预防 ICD 和 2730 例继发性预防 ICD 植入。其中[289（5.1%）]患有预先存在的癌症[原发性 140（4.8%），继发性 149（5.5%）]。患有或不患有癌症的患者之间，并未发现适当 ICD 治疗的风险存在差异[原发性癌症：19/140，无癌症：380/2795，风险比（HR）=1.07（0.67-1.69）]和[继发性癌症：42/149，无癌症：699/2581，HR=1.28（0.93-1.75）]。在原发性患者中，癌症与 1 年[癌症：10/140，无癌症：133/2795，HR=1.20（0.84-2.28）]和全时死亡率[癌症：22/140，无癌症：339/2795，HR=1.13（0.74-1.75）]无关。在继发性患者中，癌症与 1 年[癌症：19/149，无癌症：108/2581，HR=2.62（1.60-4.29）]和全时死亡率[癌症：44/149，无癌症：315/2581，HR=2.36（1.71-3.24）]的风险更高相关。
在癌症患者中，植入式心脏复律除颤器的植入比例较低。在植入指征方面，癌症和非癌症患者之间，适当治疗的风险无差异。癌症与继发性预防 ICD 患者的死亡率增加相关，但与原发性预防 ICD 患者无关。在继发性预防 ICD 患者中，大多数死亡归因于癌症。
