老年患者 ICD 治疗：一项回顾性单中心死亡率分析。
ICD therapy in the elderly: a retrospective single-center analysis of mortality.
机构信息
Department of Electrophysiology, Cologne, University Heart Center Cologne, Kerpener Str. 62, 50937, Köln, Germany.
Cardiology, Clinic Ernst von Bergmann, Potsdam, Germany.
出版信息
Herzschrittmacherther Elektrophysiol. 2021 Jun;32(2):250-256. doi: 10.1007/s00399-021-00742-x. Epub 2021 Jan 29.
BACKGROUND
Current implantable cardioverter-defibrillator (ICD) guidelines do not impose age limitations for ICD implantation (IMPL) and generator exchange (GE); however, patients (pts) should be expected to survive for 1 year. With higher age, comorbidity and mortality due to non-sudden cardiac death increase. Thus, the benefit of ICD therapy in elderly pts remains unclear. Mortality after ICD IMPL or GE in pts ≥ 75 years was assessed.
METHODS
Consecutive pts aged ≥ 75 years with ICD IMPL or GE at the University Hospital Cologne, Germany, between 01/2013 and 12/2017 were included in this retrospective analysis.
RESULTS
Of 418 pts, 82 (20%) fulfilled the inclusion criteria; in 70 (55 = IMPL, 79%, 15 = GE, 21%) follow-up (FU) was available. The median FU was 3.1 years. During FU, 40 pts (57%) died (29/55 [53%] IMPL; 11/15 [73%] GE). Mean survival after surgery was 561 ± 462 days. The 1‑year mortality rate was 19/70 (27%) overall, 9/52 (17%) in pts ≥ 75 and 10/18 (56%) in pts ≥ 80 years. Deceased pts were more likely to suffer from chronic renal failure (85% vs. 53%, p = 0.004) and peripheral artery disease (18% vs. 0%, p = 0.02). During FU, seven pts experienced ICD shocks (four appropriate, three inappropriate). In primary prevention (n = 35) mortality was 46% and four pts experienced ICD therapies (two adequate); in secondary prevention (n = 35) mortality was 69% (p = 0.053) with three ICD therapies (two adequate).
CONCLUSION
Mortality in ICD pts aged ≥ 80 years was 56% at 1 and 72% at 2 years in this retrospective analysis. The decision to implant an ICD in elderly pts should be made carefully and individually.
背景
目前的植入式心脏复律除颤器（ICD）指南并未对 ICD 植入（IMPL）和更换（GE）规定年龄限制；然而，患者应预期能存活 1 年。随着年龄的增长，由于非突发性心源性死亡导致的合并症和死亡率增加。因此，ICD 治疗在老年患者中的获益仍不清楚。评估了在德国科隆大学医院接受 ICD IMPL 或 GE 的年龄≥75 岁患者的死亡率。
方法
回顾性分析了 2013 年 1 月至 2017 年 12 月期间在德国科隆大学医院接受 ICD IMPL 或 GE 的年龄≥75 岁的连续患者，共纳入 418 例患者，其中 82 例（20%）符合纳入标准；70 例（55 例 IMPL，79%，15 例 GE，21%）有随访数据。中位随访时间为 3.1 年。随访期间，40 例患者（57%）死亡（55 例 IMPL 中有 29 例[53%]；15 例 GE 中有 11 例[73%]）。术后平均生存时间为 561±462 天。总体 1 年死亡率为 19/70（27%），75 岁及以上患者为 9/52（17%），80 岁及以上患者为 10/18（56%）。死亡患者更可能患有慢性肾衰竭（85%比 53%，p=0.004）和外周动脉疾病（18%比 0%，p=0.02）。随访期间，7 例患者经历 ICD 电击（4 次为适当，3 次为不适当）。在一级预防（n=35）中，死亡率为 46%，4 例患者经历 ICD 治疗（2 次为适当）；在二级预防（n=35）中，死亡率为 69%（p=0.053），有 3 次 ICD 治疗（2 次为适当）。
结论
在这项回顾性分析中，年龄≥80 岁的 ICD 患者 1 年和 2 年的死亡率分别为 56%和 72%。在老年患者中植入 ICD 的决定应谨慎并个体化做出。
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