O'Connor C M, Carson P E, Miller A B, Pressler M L, Belkin R N, Neuberg G W, Frid D J, Cropp A B, Anderson S, Wertheimer J H, DeMets D L
Duke Clinical Research Institute, Durham, North Carolina, USA.
Am J Cardiol. 1998 Oct 1;82(7):881-7. doi: 10.1016/s0002-9149(98)00496-2.
Investigations of calcium antagonists in patients with advanced heart failure have raised concern over an increased risk of worsening heart failure and heart failure deaths. We assessed the effect of amlodipine on cause-specific mortality in such patients enrolled in a randomized, double-blind, placebo-controlled trial. In total, 1,153 patients in New York Heart Association class IIIb or IV heart failure were randomized to receive amlodipine or placebo, along with angiotensin-converting enzyme inhibitors, diuretics, and digitalis. Over a median 14.5 months of follow-up, 413 patients died. Cardiovascular deaths accounted for 89% of fatalities, 50% of which were sudden deaths and 45% of which were due to pump failure, with fewer attributed to myocardial infarction (3.3%) or other cardiovascular causes (1.6%). Amlodipine treatment resulted in a greater relative reduction in sudden deaths (21%) than in pump failure deaths (6.6%) overall. When patients were classified by etiology of heart failure (ischemic or nonischemic), cause-specific mortality did not differ significantly between treatment groups in the ischemic stratum. In the nonischemic stratum, however, sudden deaths and pump failure deaths were reduced by 38% and 45%, respectively, with amlodipine. Thus, when added to digitalis, diuretics, and angiotensin-converting enzyme inhibitors in patients with advanced heart failure, amlodipine appears to have no effect on cause-specific mortality in ischemic cardiomyopathy, but both pump failure and sudden deaths appear to be decreased in nonischemic heart failure patients treated with amlodipine.
对晚期心力衰竭患者使用钙拮抗剂的研究引发了人们对心力衰竭恶化风险和心力衰竭死亡风险增加的担忧。我们评估了氨氯地平对参加一项随机、双盲、安慰剂对照试验的此类患者特定病因死亡率的影响。共有1153名纽约心脏病协会心功能IIIb级或IV级心力衰竭患者被随机分配接受氨氯地平或安慰剂治疗，同时服用血管紧张素转换酶抑制剂、利尿剂和洋地黄。在中位随访14.5个月期间，有413名患者死亡。心血管死亡占死亡总数的89%，其中50%为猝死，45%是由于泵衰竭，因心肌梗死导致的死亡占3.3%，因其他心血管原因导致的死亡占1.6%。总体而言，氨氯地平治疗导致的猝死相对减少幅度（21%）大于泵衰竭死亡的相对减少幅度（6.6%）。当根据心力衰竭病因（缺血性或非缺血性）对患者进行分类时，缺血性亚组中治疗组之间的特定病因死亡率没有显著差异。然而，在非缺血性亚组中，氨氯地平使猝死和泵衰竭死亡分别减少了38%和45%。因此，在晚期心力衰竭患者中，当氨氯地平与洋地黄、利尿剂和血管紧张素转换酶抑制剂联用时，它似乎对缺血性心肌病患者的特定病因死亡率没有影响，但在接受氨氯地平治疗的非缺血性心力衰竭患者中，泵衰竭和猝死似乎都有所减少。
