Powell A C, Fuchs T, Finkelstein D M, Garan H, Cannom D S, McGovern B A, Kelly E, Vlahakes G J, Torchiana D F, Ruskin J N
Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston 02114.
Circulation. 1993 Sep;88(3):1083-92. doi: 10.1161/01.cir.88.3.1083.
Survivors of out-of-hospital cardiac arrest not associated with acute myocardial infarction are at high risk for recurrent cardiac arrest and sudden cardiac death. The impact of the implantable cardioverter-defibrillator on long-term prognosis in these patients is uncertain.
Three hundred thirty-one survivors of out-of-hospital cardiac arrest (age, 56 +/- 13.7 years) underwent electrophysiologically guided therapy. Implantable defibrillators were placed in 150 patients (45.3%), and 181 patients (54.7%) received pharmacological and/or surgical therapy alone. Left ventricular ejection fraction was 35.2 +/- 16.6% in defibrillator recipients and 45.3 +/- 18.2% in nondefibrillator patients. Median patient follow-up was 24 months in the defibrillator group and 46 months in the nondefibrillator group. In a proportional hazards model, the independent predictors of total cardiac mortality were left ventricular ejection fraction of less than 0.40 (relative risk, 4.55; 95% confidence interval, 2.44 to 8.33; P = .0001), absence of an implantable defibrillator (relative risk, 2.70; confidence interval, 1.41 to 5.00; P = .017), and persistence of inducible sustained ventricular tachycardia (relative risk, 1.84; 95% confidence interval, 0.97 to 3.49; P = .045). The 1- and 5-year probabilities of survival free of cardiac mortality in patients with left ventricular ejection fraction of less than 0.40 were 94.3% and 69.6% with a defibrillator and 82.1% and 45.3% without a defibrillator, respectively. For patients with left ventricular ejection fraction of 0.40 or more, the 1- and 5-year probabilities of survival free of cardiac mortality were 97.7% and 94.6% with a defibrillator and 95.4% and 86.9% without a defibrillator, respectively.
In survivors of out-of-hospital cardiac arrest, the implantable defibrillator is associated with a reduction in cardiac mortality, particularly in patients with impaired left ventricular function.
非急性心肌梗死所致院外心脏骤停幸存者发生心脏骤停复发及心源性猝死的风险很高。植入式心脏复律除颤器对这些患者长期预后的影响尚不确定。
331例院外心脏骤停幸存者（年龄56±13.7岁）接受了电生理指导下的治疗。150例患者（45.3%）植入了除颤器，181例患者（54.7%）仅接受了药物和/或手术治疗。接受除颤器治疗患者的左心室射血分数为35.2±16.6%，未接受除颤器治疗患者的左心室射血分数为45.3±18.2%。除颤器组患者的中位随访时间为24个月，未接受除颤器治疗组患者的中位随访时间为46个月。在比例风险模型中，心脏总死亡率的独立预测因素为左心室射血分数小于0.40（相对风险4.55；95%置信区间2.44至8.33；P = 0.0001）、未植入除颤器（相对风险2.70；置信区间1.41至5.00；P = 0.017）以及可诱导性持续性室性心动过速持续存在（相对风险1.84；95%置信区间0.97至3.49；P = 0.045）。左心室射血分数小于0.40的患者，植入除颤器时1年和5年无心脏死亡生存率分别为94.3%和69.6%，未植入除颤器时分别为82.1%和45.3%。对于左心室射血分数为0.40或更高的患者，植入除颤器时1年和5年无心脏死亡生存率分别为97.7%和94.6%，未植入除颤器时分别为95.4%和86.9%。
在院外心脏骤停幸存者中，植入式除颤器可降低心脏死亡率，尤其是在左心室功能受损的患者中。
