Rohrer Ursula, Manninger Martin, Fiedler Lukas, Steinwender Clemens, Binder Ronald K, Stühlinger Markus, Zirngast Birgit, Zweiker David, Zirlik Andreas, Scherr Daniel
Division of Cardiology, Department of Medicine, Medical University of Graz, 8036 Graz, Austria.
Division of Internal Medicine, Cardiology and Nephrology, Department of Medicine, Hospital Wiener Neustadt, 2700 Wiener Neustadt, Austria.
J Clin Med. 2023 Jul 31;12(15):5029. doi: 10.3390/jcm12155029.
After acute myocardial infarction (AMI), patients are at risk of sudden cardiac death. The VEST trial failed to show a reduction in arrhythmic mortality in AMI patients with an LVEF ≤ 35% prescribed with a WCD, having a lower-than-expected WCD wearing compliance.
The aim was to investigate on outcomes of patients in a real-world Austrian cohort with good compliance.
A retrospective analysis of all eligible Austrian WCD patients according to the VEST trial inclusion and exclusion criteria between 2010 and 2020 was performed.
In total, 105 Austrian patients (64 ± 11 years, 12% female; LVEF 28 ± 6%) received a WCD for a median of 69 (1; 277) days after AMI (wearing duration 23.5 (0; 24) hours/day). Within the first 90 days, 4/105 (3.8%) patients received 9 appropriate shocks (2 (1; 5) shocks). No inappropriate shocks were delivered, and 3/105 (2.9%) patients died during follow-up. Arrhythmic mortality (1.9% Austria vs. 1.6% VEST, = 0.52), as well as all-cause mortality (2.9% vs. 3.1%, = 0.42) was comparable in both cohorts.
The WCD is a safe treatment option in a highly selected cohort of patients with LVEF ≤ 35% after AMI. However, despite excellent WCD wearing duration in our cohort, the arrhythmic mortality rate was not significantly different.
急性心肌梗死（AMI）后，患者有心脏性猝死的风险。VEST试验未能显示，对于左心室射血分数（LVEF）≤35%且佩戴可穿戴式心脏复律除颤器（WCD）的AMI患者，心律失常死亡率有所降低，其WCD佩戴依从性低于预期。
旨在调查奥地利一个真实世界中依从性良好的队列患者的结局。
根据VEST试验的纳入和排除标准，对2010年至2020年间所有符合条件的奥地利WCD患者进行回顾性分析。
共有105例奥地利患者（64±11岁，12%为女性；LVEF为28±6%）在AMI后接受WCD，中位时间为69（1；277）天（佩戴时长为23.5（0；24）小时/天）。在最初90天内，4/105（3.8%）例患者接受了9次恰当电击（2（1；5）次电击）。未发生不恰当电击，3/105（2.9%）例患者在随访期间死亡。两个队列的心律失常死亡率（奥地利为1.9%，VEST为1.6%，P = 0.52）以及全因死亡率（2.9%对3.1%，P = 0.42）相当。
对于AMI后LVEF≤35%的高度选择队列患者，WCD是一种安全的治疗选择。然而，尽管我们队列中的WCD佩戴时长极佳，但心律失常死亡率并无显著差异。
