Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden (B.S., A.U., L.B., M.S., D.S., C.L., F.B., G.S.).
University Heart Centre Hamburg, Department of General and Interventional Cardiology and German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Lübeck/Kiel (B.S., D.W.).
Circulation. 2019 Nov 5;140(19):1530-1539. doi: 10.1161/CIRCULATIONAHA.119.043012. Epub 2019 Sep 3.
Most randomized trials on implantable cardioverter-defibrillator (ICD) use for primary prevention of sudden cardiac death in heart failure with reduced ejection fraction enrolled patients >20 years ago. We investigated the association between ICD use and all-cause mortality in a contemporary heart failure with reduced ejection fraction cohort and examined relevant subgroups.
Patients from the Swedish Heart Failure Registry fulfilling the European Society of Cardiology criteria for primary-prevention ICD were included. The association between ICD use and 1-year and 5-year all-cause and cardiovascular (CV) mortality was assessed by Cox regression models in a 1:1 propensity score-matched cohort and in prespecified subgroups.
Of 16 702 eligible patients, only 1599 (10%) had an ICD. After matching, 1305 ICD recipients were compared with 1305 nonrecipients. ICD use was associated with a reduction in all-cause mortality risk within 1 year (hazard ratio, 0.73 [95% CI, 0.60-0.90]) and 5 years (hazard ratio, 0.88 [95% CI, 0.78-0.99]). Results were consistent in all subgroups including patients with versus without ischemic heart disease, men versus women, those aged <75 versus ≥75 years, those with earlier versus later enrollment in the Swedish heart failure registry, and patients with versus without cardiac resynchronization therapy.
In a contemporary heart failure with reduced ejection fraction population, ICD for primary prevention was underused, although it was associated with reduced short- and long-term all-cause mortality. This association was consistent across all the investigated subgroups. These results call for better implementation of ICD therapy.
大多数关于植入式心脏复律除颤器（ICD）用于心力衰竭伴射血分数降低患者一级预防心源性猝死的随机试验都是在 20 多年前进行的。我们研究了 ICD 使用与当代心力衰竭伴射血分数降低患者全因死亡率之间的相关性，并对相关亚组进行了研究。
从符合欧洲心脏病学会一级预防 ICD 标准的瑞典心力衰竭注册登记处中选取患者。采用 Cox 回归模型评估 1 年和 5 年全因死亡率和心血管死亡率与 ICD 使用之间的相关性，并在 1:1 倾向评分匹配队列和预设亚组中进行评估。
在 16702 例符合条件的患者中，仅有 1599 例（10%）植入了 ICD。匹配后，将 1305 例 ICD 使用者与 1305 例非使用者进行比较。ICD 治疗可降低 1 年内（风险比，0.73 [95%CI，0.60-0.90]）和 5 年内（风险比，0.88 [95%CI，0.78-0.99]）的全因死亡率。在包括有缺血性心脏病与无缺血性心脏病、男性与女性、年龄<75 岁与≥75 岁、瑞典心力衰竭注册登记处较早与较晚入组、有与无心脏再同步治疗的患者在内的所有亚组中，结果均一致。
在当代心力衰竭伴射血分数降低的人群中，尽管 ICD 用于一级预防与降低短期和长期全因死亡率相关，但 ICD 的使用仍不足。这种相关性在所有研究的亚组中均一致。这些结果表明，需要更好地实施 ICD 治疗。
