Division of Cardiology, Duke University Medical Center, Durham, North Carolina; Duke Clinical Research Institute, Durham, North Carolina.
Duke Clinical Research Institute, Durham, North Carolina.
Am J Cardiol. 2021 Jan 1;138:26-32. doi: 10.1016/j.amjcard.2020.09.056. Epub 2020 Oct 15.
The purpose of this analysis was to assess implantable cardioverter-defibrillator (ICD) utilization and its association with mortality among patients ≥65 years of age after coronary revascularization. Patients in the National Cardiovascular Database Registry Chest Pain-Myocardial Infarction (MI) Registry who presented with MI from January 2, 2009 to December 31, 2016, had a left ventricular ejection fraction ≤35% and underwent in-hospital revascularization (10,014 percutaneous coronary intervention (PCI) and 1,647 coronary artery bypass grafting (CABG)) were linked with Medicare claims to determine rates of 1-year ICD implantation. The association between ICD implantation and 2-year mortality was assessed. Of 11,661 included patients, an ICD was implanted in 1,234 (10.6%) within 1 year of revascularization (1,063 (10.6%) PCI and 171 (10.4%) CABG). Among PCI-treated patients, in-hospital ventricular arrhythmia (adjusted hazard ratio [aHR] 1.60, 95% confidence interval [CI] 1.34 to 1.92), 2-week cardiology follow-up (aHR 1.48, 95% CI 1.29 to 1.70), readmission for heart failure (aHR 3.21, 95% CI 2.73 to 3.79), and readmission for MI (aHR 2.18, 95% CI 1.66 to 2.85) were positively associated with ICD implantation. Among CABG-treated patients, in-hospital ventricular arrhythmia (aHR 2.33, 95% CI 1.39 to 3.91), and heart failure readmission (aHR 3.14, 95% CI 1.96 to 5.04) were positively associated with ICD implantation. Women were less likely to receive an ICD, regardless of the revascularization strategy. ICD implantation was associated with lower 2-year all-cause mortality (aHR 0.74, 95% CI 0.63 to 0.86). In conclusion, only 1 in 10 Medicare patients with low ejection fraction received an ICD within 1 year after revascularization. Contact with the healthcare system after discharge was associated with higher likelihood of ICD implantation. ICD implantation was associated with lower mortality following revascularization for MI.
本分析的目的是评估植入式心脏复律除颤器（ICD）的使用情况及其与冠状动脉血运重建后≥65 岁患者死亡率之间的相关性。2009 年 1 月 2 日至 2016 年 12 月 31 日，国家心血管数据库注册胸痛-心肌梗死（MI）登记处的患者因 MI 就诊，左心室射血分数≤35%并接受院内血运重建（10014 例经皮冠状动脉介入治疗（PCI）和 1647 例冠状动脉旁路移植术（CABG）），与医疗保险索赔相关联，以确定 1 年内 ICD 植入率。评估了 ICD 植入与 2 年死亡率之间的相关性。在纳入的 11661 名患者中，1063 例（10.6%）PCI 治疗患者和 171 例（10.4%）CABG 治疗患者在血运重建后 1 年内植入了 ICD（1234 例[10.6%]）。在接受 PCI 治疗的患者中，院内室性心律失常（校正后的危险比[aHR]1.60，95%置信区间[CI]1.34 至 1.92）、2 周时心内科随访（aHR 1.48，95%CI 1.29 至 1.70）、心力衰竭再入院（aHR 3.21，95%CI 2.73 至 3.79）和再次因心肌梗死入院（aHR 2.18，95%CI 1.66 至 2.85）与 ICD 植入呈正相关。在接受 CABG 治疗的患者中，院内室性心律失常（aHR 2.33，95%CI 1.39 至 3.91）和心力衰竭再入院（aHR 3.14，95%CI 1.96 至 5.04）与 ICD 植入呈正相关。无论血运重建策略如何，女性接受 ICD 的可能性都较低。ICD 植入与较低的 2 年全因死亡率（aHR 0.74，95%CI 0.63 至 0.86）相关。总之，只有 10%的 Medicare 低射血分数患者在血运重建后 1 年内接受了 ICD。出院后的医疗接触与 ICD 植入的可能性更高相关。ICD 植入与 MI 血运重建后死亡率降低相关。
