Queen Elizabeth II Health Sciences Center, HI Site, 1796 Summer Street, Room 2501D, Halifax, Nova Scotia, Canada.
College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.
BMC Cardiovasc Disord. 2020 Oct 21;20(1):455. doi: 10.1186/s12872-020-01726-4.
There is clear evidence that patients with prior myocardial infarction and a reduced ejection fraction benefit from implantation of a cardioverter-defibrillator (ICD). It is unclear whether this benefit is altered by whether or not revascularization is performed prior to ICD implantation.
This was a retrospective cohort study following patients who underwent ICD implantation from 2002 to 2014. Patients with ischemic cardiomyopathy and either primary or secondary prevention ICDs were selected for inclusion. Using the electronic medical record, cardiac catheterization data, revascularization status (percutaneous coronary intervention or coronary bypass surgery) were recorded. The outcomes were mortality and ventricular arrhythmia.
There were 606 patients included in the analysis. The mean age was 66.3 ± 10.1 years, 11.9% were women, and the mean LVEF was 30.5 ± 12.0, 58.9% had a primary indication for ICD, 82.0% of the cohort had undergone coronary catheterization prior to ICD implantation. In the overall cohort, there were fewer mortality and ventricular arrhythmia events in patients who had undergone prior revascularization. In patients who had an ICD for secondary prevention, revascularization was associated with a decrease in mortality (HR 0.46, 95% CI (0.24, 0.85) p = 0.015), and a trend towards fewer ventricular arrhythmia (HR 0.62, 95% CI (0.38, 1.00) p = 0.051). There was no association between death or ventricular arrhythmia with revascularization in patients with primary prevention ICDs.
Revascularization may be beneficial in preventing recurrent ventricular arrhythmia, and should be considered as adjunctive therapy to ICD implantation to improve cardiovascular outcomes.
有明确的证据表明，患有先前心肌梗死和射血分数降低的患者从植入心脏转复除颤器（ICD）中获益。尚不清楚在 ICD 植入之前是否进行血运重建是否会改变这种获益。
这是一项回顾性队列研究，对 2002 年至 2014 年间接受 ICD 植入的患者进行随访。选择患有缺血性心肌病和原发性或继发性预防 ICD 的患者纳入研究。使用电子病历、心导管检查数据和血运重建状态（经皮冠状动脉介入治疗或冠状动脉旁路手术）进行记录。结局为死亡率和室性心律失常。
共纳入 606 例患者进行分析。患者的平均年龄为 66.3±10.1 岁，11.9%为女性，平均 LVEF 为 30.5±12.0，58.9%为 ICD 的原发性适应证，82.0%的患者在 ICD 植入前接受过冠状动脉造影检查。在整个队列中，接受过血运重建的患者死亡率和室性心律失常发生率较低。对于因继发性预防而植入 ICD 的患者，血运重建与死亡率降低相关（HR 0.46，95%CI（0.24，0.85），p=0.015），且室性心律失常发生率也呈下降趋势（HR 0.62，95%CI（0.38，1.00），p=0.051）。在因原发性预防而植入 ICD 的患者中，血运重建与死亡或室性心律失常之间无相关性。
血运重建可能有益于预防复发性室性心律失常，应考虑将其作为 ICD 植入的辅助治疗方法，以改善心血管结局。
