Rusnak Jonas, Behnes Michael, Schupp Tobias, Weiß Christel, Nienaber Christoph, Lang Siegfried, Reiser Linda, Bollow Armin, Taton Gabriel, Reichelt Thomas, Ellguth Dominik, Engelke Niko, Ansari Uzair, El-Battrawy Ibrahim, Bertsch Thomas, Akin Muharrem, Mashayekhi Kambis, Borggrefe Martin, Akin Ibrahim
First Department of Medicine, University Medical Center Mannheim, Faculty of Medicine Mannheim, University of Heidelberg, European Center for AngioScience (ECAS), and DZHK (German Center for Cardiovascular Research) partner site Heidelberg/Mannheim.
Institute of Biomathematics and Medical Statistics, University Medical Center Mannheim, Faculty of Medicine Mannheim, Heidelberg University, Mannheim.
Coron Artery Dis. 2019 Jun;30(4):303-311. doi: 10.1097/MCA.0000000000000738.
The study sought to assess the impact of ischemic cardiomyopathy (ICMP) and nonischemic cardiomyopathy (NICMP) on secondary survival in patients presenting with ventricular tachyarrhythmias and aborted sudden cardiac arrest (SCA).
Data regarding the outcome of patients with ICMP or NICMP presenting with ventricular tachyarrhythmias or aborted SCA is limited.
A large retrospective registry was used including all consecutive patients presenting with ventricular tachycardia (VT), ventricular fibrillation (VF), or aborted SCA on admission from 2002 to 2016. ICMP and NICMP were compared applying univariable correlation models and propensity score matching for evaluation of the primary prognostic end point defined as long-term all-cause mortality at 2.5 years. Secondary end points were all-cause mortality at 30 days, at index hospitalization, and after discharge; the composite end point of recurrent ventricular tachyarrhythmias, cardiac death at 24 h, and appropriate implantable cardioverter defibrillator (ICD) therapy; and finally, rehospitalization related to ventricular tachyarrhythmias.
A total of 276 matched patients were included. The rates of VT and VF were similar in both groups (VT: 75 vs. 73%; VF: 23 vs. 22%). At 2.5 years, no differences were found regarding the primary end point of all-cause mortality in both patients with ICMP and NICMP (mortality rate: 33 vs. 32%; log-rank P=0.898). Similar survival was present irrespective of the presence of acute myocardial infarction, underlying ventricular tachyarhythmia (VT/VF), left ventricular dysfunction, and an activated ICD. Furthermore, no significant differences could be seen regarding secondary end points of all-cause mortality at 30 days, at index hospitalization, and after discharge; the composite end point of recurrent ventricular tachyarrhythmias, cardiac death at 24 h, and appropriate ICD interrogation; and finally rehospitalization related to ventricular tachyarrhythmias.
Both ICMP and NICMP reveal comparable secondary survival after episodes of ventricular tachyarrhythmias or SCA on admission.
本研究旨在评估缺血性心肌病（ICMP）和非缺血性心肌病（NICMP）对出现室性快速心律失常和心脏骤停（SCA）未遂患者的二次生存的影响。
关于ICMP或NICMP患者出现室性快速心律失常或SCA未遂的预后数据有限。
使用了一个大型回顾性登记数据库，纳入了2002年至2016年期间所有入院时出现室性心动过速（VT）、室颤（VF）或SCA未遂的连续患者。应用单变量相关模型和倾向评分匹配对ICMP和NICMP进行比较，以评估定义为2.5年长期全因死亡率的主要预后终点。次要终点包括30天、首次住院期间及出院后的全因死亡率；室性快速心律失常复发、24小时心脏死亡和合适的植入式心律转复除颤器（ICD）治疗的复合终点；以及最后与室性快速心律失常相关的再住院情况。
共纳入276例匹配患者。两组的VT和VF发生率相似（VT：75%对73%；VF：23%对22%）。在2.5年时，ICMP和NICMP患者的全因死亡率主要终点未发现差异（死亡率：33%对32%；对数秩检验P = 0.898）。无论是否存在急性心肌梗死、潜在的室性快速心律失常（VT/VF）、左心室功能障碍和激活的ICD，生存情况相似。此外，在30天、首次住院期间及出院后的全因死亡率次要终点；室性快速心律失常复发、24小时心脏死亡和合适的ICD询问的复合终点；以及最后与室性快速心律失常相关的再住院情况方面，均未发现显著差异。
ICMP和NICMP在入院时出现室性快速心律失常或SCA发作后的二次生存情况相当。
