新型治疗药物时代非缺血性心肌病患者植入式心律转复除颤器一级预防的荟萃分析

Implantable cardioverter defibrillator for primary prevention in patients with non-ischemic cardiomyopathy in the era of novel therapeutic agents- meta-analysis.

作者信息

Kolben Yotam, Hirsh Raccah Bruria, Koev Ivelin, Luria David, Amir Offer, Biton Yitschak

机构信息

Heart Institute, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.

Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom.

出版信息

Front Cardiovasc Med. 2023 May 19;10:1192101. doi: 10.3389/fcvm.2023.1192101. eCollection 2023.

DOI:10.3389/fcvm.2023.1192101

PMID:37283572

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10240391/

Abstract

BACKGROUND

Evidence regarding the mortality benefit of implantable cardioverter defibrillator (ICD) non-ischemic dilated cardiomyopathy (NIDCM) is inconsistent. The most recent randomized study, the DANISH trial, did not find improved outcomes with ICD. However, based on previous studies and meta-analyses, current guidelines still highly recommend ICD implantation in NIDCM patients. The introduction of novel medications for heart failure improved the clinical outcome dramatically. We aimed in this study to evaluate the effect of Angiotensin Receptor-Neprilysin Inhibitors (ARNi) and sodium-glucose transport protein 2 inhibitors (SGLT2i) on the mortality benefit of ICD in NIDCM.

METHODS

We used a previous metanalysis algorithm and added an updated comprehensive literature search in PubMed for randomized control trials that examined the mortality benefit of ICD in NIDCM vs. optimal medical treatment. The primary outcome included death from any cause. We did a meta-regression analysis to search for a single independent factor affecting mortality. Using previous data, we evaluated the theoretical effect of ICD implementation on patients treated with SGLT2 inhibitors and ARNi.

RESULTS

No new articles were added to the results of the previous meta-analysis. 2,622 patients with NIDCM from 5 cohort studies published between 2002 and 2016 were included in the analysis. 50% of them underwent ICD implantation for primary prevention of sudden cardiac death, and 50% did not. ICD was associated with a significantly decreased risk for death from any cause compared to control (OR = 0.79, 95%CI: 0.66-0.95, = 0.01, = 0%). The theoretical addition of ARNi and the SGLT2 inhibitor dapagliflozin did not change the significant mortality effect of ICD (OR = 0.82, 95%CI: 0.7-0.9, = 0.001, = 0%) and (OR = 0.82, 95%CI: 0.7-0.9, = 0.001, = 0%). A meta-regression revealed no association between death from any cause and left bundle branch block (LBBB), use of amiodarone, use of angiotensin-converting enzyme inhibitors (ACEi) or angiotensin receptor blockers, year initiated enrollment, and the year ended enrollment ( = 0.0).

CONCLUSION

In patients with NIDCM, the addition of ARNi and SGLT2i did not affect the mortality advantages of ICD for primary prevention.

PROSPERO REGISTRY NUMBER

https://www.crd.york.ac.uk/prospero/, identifier: CRD42023403210.

摘要

背景

关于植入式心脏复律除颤器（ICD）对非缺血性扩张型心肌病（NIDCM）患者死亡率益处的证据并不一致。最近的一项随机研究——丹麦试验，未发现ICD能改善预后。然而，基于既往研究和荟萃分析，当前指南仍强烈推荐在NIDCM患者中植入ICD。新型心力衰竭药物的引入显著改善了临床结局。本研究旨在评估血管紧张素受体脑啡肽酶抑制剂（ARNi）和钠-葡萄糖协同转运蛋白2抑制剂（SGLT2i）对ICD在NIDCM患者中死亡率益处的影响。

方法

我们使用了先前的荟萃分析算法，并在PubMed中进行了更新的全面文献检索，以查找比较ICD与最佳药物治疗在NIDCM患者中死亡率益处的随机对照试验。主要结局包括任何原因导致的死亡。我们进行了荟萃回归分析，以寻找影响死亡率的单一独立因素。利用先前的数据，我们评估了ICD植入对接受SGLT2抑制剂和ARNi治疗患者的理论效果。

结果

先前荟萃分析的结果未增加新的文章。分析纳入了2002年至2016年间发表的5项队列研究中的2622例NIDCM患者。其中50%接受ICD植入以预防心源性猝死，50%未接受。与对照组相比，ICD与任何原因导致的死亡风险显著降低相关（OR = 0.79，95%CI：0.66 - 0.95，P = 0.01，I² = 0%）。理论上添加ARNi和SGLT2抑制剂达格列净并未改变ICD显著的死亡率影响（OR = 0.82，95%CI：0.7 - 0.9，P = 0.001，I² = 0%）以及（OR = 0.82，95%CI：0.7 - 0.9，P = 0.001，I² = 0%）。荟萃回归显示，任何原因导致的死亡与左束支传导阻滞（LBBB）、胺碘酮的使用、血管紧张素转换酶抑制剂（ACEi）或血管紧张素受体阻滞剂的使用、开始入组年份以及结束入组年份之间均无关联（P = 0.0）。