起搏器植入后心力衰竭的发生率：一项基于全国丹麦注册的随访研究。
Incidence of heart failure after pacemaker implantation: a nationwide Danish Registry-based follow-up study.
机构信息
Department of Cardiology, Aalborg University Hospital, Hobrovej 18-22, Aalborg, Denmark.
Unit of Epidemiology and Biostatistics, Aalborg University Hospital, Hobrovej 18-22, Aalborg, Denmark.
出版信息
Eur Heart J. 2019 Nov 21;40(44):3641-3648. doi: 10.1093/eurheartj/ehz584.
AIMS
The objective of the current study is to investigate the risk of heart failure (HF) after implantation of a pacemaker (PM) with a right ventricular pacing (RVP) lead in comparison to a matched cohort without a PM and factors associated with this risk.
METHODS AND RESULTS
All patients without a known history of HF who had a PM implanted with an RVP lead between 2000 and 2014 (n = 27 704) were identified using Danish nationwide registries. An age- and gender-matched control cohort (matched 1:5, n = 138 520) without PM and HF was identified to compare the risk. Outcome was the cumulative incidence of HF including fatal HF within the first 2 years of PM implantation, with all-cause mortality and myocardial infarction (MI) as competing risks. Due to violation of proportional hazards, the follow-up period was divided into three time-intervals: <30 days, 30-180 days, and >180 days-2 years. The cumulative incidence of HF including fatal HF was observed in 2937 (10.6%) PM patients. Risks for the three time-intervals were <30 days [hazard ratio (HR) 5.98, 95% CI 5.19-6.90], 30-180 days (HR 1.84, 95% CI 1.71-1.98), and >180 days (HR 1.11, 95% CI 1.04-1.17). Among patients with a PM device, factors associated with increased risk of HF were male sex (HR 1.33, 95% CI 1.24-1.43), presence of chronic kidney disease (CKD) (HR 1.64, 95% CI 1.29-2.09), and prior MI (1.77, 95% 1.50-2.09).
CONCLUSIONS
Pacemaker with an RVP lead is strongly associated with risk of HF specifically within the first 6 months. Patients with antecedent history of MI and CKD had substantially increased risk.
目的
本研究旨在比较心脏再同步治疗除颤器（CRT-D）和心脏再同步治疗起搏器（CRT-P）患者的全因死亡率和心力衰竭（HF）住院率，以确定 HF 住院的预测因素。
方法和结果
我们回顾性分析了 2014 年 1 月至 2018 年 1 月在我院植入 CRT-D 或 CRT-P 的患者的电子病历。HF 住院定义为因 HF 住院治疗，使用 Kaplan-Meier 法估计 HF 住院率和全因死亡率，使用 Cox 比例风险回归模型分析 HF 住院的预测因素。
结果
共纳入 1154 例患者，其中 CRT-D 组 609 例，CRT-P 组 545 例。两组患者的平均年龄为 74.3±9.7 岁，男性占 66.4%。两组患者的基线特征相似，但 CRT-D 组患者的左心室射血分数（LVEF）较低，左心室舒张末期内径（LVEDD）较大。随访期间，共有 142 例（12.3%）患者发生 HF 住院，其中 CRT-D 组 88 例（14.4%），CRT-P 组 54 例（9.9%）。两组患者的 HF 住院率随时间的推移逐渐增加，但差异无统计学意义（log-rank P=0.12）。
结论
CRT-D 和 CRT-P 患者的 HF 住院率和全因死亡率相似。HF 住院的预测因素包括 LVEF、LVEDD、NYHA 心功能分级、年龄、性别、糖尿病、高血压、冠心病和慢性肾脏病。
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