JAMA Cardiol:老年晚期心衰患者中与植入式心脏复律除颤器相关的围手术期风险和生存率

2020-03-28 xiangting MedSci原创

在接受ICD或CRT-D植入以预防心源性猝死的患者中,只有一小部分患者为晚期HF。与非晚期HF患者相比,这些患者与院内死亡和心脏骤停相关的临床重要围手术期并发症的发生率较高。

目前对植入式心脏复律除颤器(ICD)和心脏再同步化治疗除颤器(CRT-D)在晚期心衰(HF)患者中的利用率和结局知之甚少。

这项研究旨在探讨晚期HF患者ICD和CRT-D植入的利用率、患者特征以及结局。

这项队列研究是对2010年1月至2014年12月国家心血管数据登记ICD注册纳入的81492例医疗保险服务费受益人进行的事后分析。纳入标准为诊断为HF,且左室射血分数低于35%,并有晚期HF证据,晚期HF证据定义为有纽约心脏病协会(NYHA)IV级症状,最近60天内使用强心剂,原位左心室辅助装置或等待原位心脏移植。对照组纳入最近12个月内NYHA II级,无心衰住院,无左心室辅助装置,没有等待原位心脏移植以及目前或近期未使用强心剂的患者。所有符合条件的患者都进行了首次ICD或CRT-D植入,以初步预防心源性猝死。分析了2010年1月至2014年12月的数据。

主要结局和指标是全因死亡率和围手术期并发症。

在81492例医疗保险患者中,3343例患有晚期心衰(4.1%),而对照组有19424例患者(23.8%)。在晚期HF人群中,患者的平均(SD)年龄为74(9)岁,患者主要为白人(81.5%)和男性(71.1%)。晚期HF组30天的全因死亡率为3.1%(95%CI,2.6%-3.8%),而对照组为0.5%(0.4%-0.6%)(P<.001)。在晚期HF人群中,总的院内围手术期并发症发生率为3.74%(95%CI,3.12%-4.44%),而对照组为1.10%(95%CI,0.95%-1.25%)(P<.001)。该组中大多数不良事件为院内死亡(1.82%;95%CI,1.40%-2.34%)和复苏的心脏骤停(1.05%;95%CI,0.73%-1.45%)。NYHA分级IV级(危险比,1.40;95%CI,1.02-1.93;P= .04)、缺血性心脏病(危险比,1.24;95%CI,1.04-1.48;P= .02)或糖尿病患者(危险比,1.17;95%CI,1.04-1.33;P= 0.01)的死亡风险更高。

在接受ICD或CRT-D植入以预防心源性猝死的患者中,只有一小部分患者为晚期HF。与非晚期HF患者相比,这些患者与院内死亡和心脏骤停相关的临床重要围手术期并发症的发生率较高。

原始出处:

Marat Fudim. Periprocedural Risk and Survival Associated With Implantable Cardioverter-Defibrillator Placement in Older Patients With Advanced Heart Failure. JAMA Cardiology. 25 March 2020.

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  4. 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  5. 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  6. 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authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyheQLjPSX3OUs5GmkyBlcCOwTPIeq3why9NGibxxUqYo6hcx8qZLHZFgNPnBK1yzWeOFpyg2OnWOt0/0, createdBy=fa4716, createdName=zhouqu_8, createdTime=Mon Mar 30 02:44:09 CST 2020, time=2020-03-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1520666, encodeId=6ed2152066683, content=<a href='/topic/show?id=7a736264553' target=_blank style='color:#2F92EE;'>#植入#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=62645, encryptionId=7a736264553, topicName=植入)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=832411313664, createdName=jiyangfei, createdTime=Mon Mar 30 02:44:09 CST 2020, time=2020-03-30, status=1, ipAttribution=)]
    2020-06-08 villahu
  7. 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createdBy=d7532500500, createdName=12499e01m47暂无昵称, createdTime=Wed Sep 23 21:44:09 CST 2020, time=2020-09-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2053893, encodeId=bc9b205389310, content=<a href='/topic/show?id=8f5a54442a1' target=_blank style='color:#2F92EE;'>#手术期#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=54442, encryptionId=8f5a54442a1, topicName=手术期)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/WQ1WyMBGic8d2fKdCe6Cm3vaRh4X8YnlumYndC46iagNCBl9Df8RtoCaQchnFtZldHUctGJjsgsyutUlu8vPq6yQ/132, createdBy=97862500016, createdName=ms3117646317107274, createdTime=Thu Nov 26 03:44:09 CST 2020, time=2020-11-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1709375, encodeId=98951e09375e8, content=<a href='/topic/show?id=bf4e514e25b' target=_blank style='color:#2F92EE;'>#心脏复律#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=51472, encryptionId=bf4e514e25b, topicName=心脏复律)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=hb2008ye, createdTime=Fri Jun 19 03:44:09 CST 2020, time=2020-06-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2032432, encodeId=058f20324324d, content=<a href='/topic/show?id=dd32514e318' target=_blank style='color:#2F92EE;'>#心脏复律除颤器#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=51473, encryptionId=dd32514e318, topicName=心脏复律除颤器)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=cfa576, createdName=wfang545, createdTime=Mon Oct 12 01:44:09 CST 2020, time=2020-10-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1748754, 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CST 2020, time=2020-03-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1373476, encodeId=5dce13e347687, content=<a href='/topic/show?id=2fd051939ab' target=_blank style='color:#2F92EE;'>#心衰患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=51939, encryptionId=2fd051939ab, topicName=心衰患者)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=467c360, createdName=yuanming7, createdTime=Mon Mar 30 02:44:09 CST 2020, time=2020-03-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1439169, encodeId=84bf14391692a, content=<a href='/topic/show?id=8e3a98396f2' target=_blank style='color:#2F92EE;'>#除颤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=98396, encryptionId=8e3a98396f2, topicName=除颤)], attachment=null, 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  8. [GetPortalCommentsPageByObjectIdResponse(id=2029140, encodeId=33a0202914091, content=<a href='/topic/show?id=d01e5982936' target=_blank style='color:#2F92EE;'>#晚期心衰#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=59829, encryptionId=d01e5982936, topicName=晚期心衰)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b78f2500065, createdName=12498761m56暂无昵称, createdTime=Tue Jun 16 14:44:09 CST 2020, time=2020-06-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1782077, encodeId=92651e8207733, content=<a href='/topic/show?id=5db8409ed8' target=_blank style='color:#2F92EE;'>#Cardiol#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=4097, encryptionId=5db8409ed8, topicName=Cardiol)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d7532500500, createdName=12499e01m47暂无昵称, createdTime=Wed Sep 23 21:44:09 CST 2020, time=2020-09-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2053893, encodeId=bc9b205389310, content=<a href='/topic/show?id=8f5a54442a1' target=_blank style='color:#2F92EE;'>#手术期#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=54442, encryptionId=8f5a54442a1, topicName=手术期)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/WQ1WyMBGic8d2fKdCe6Cm3vaRh4X8YnlumYndC46iagNCBl9Df8RtoCaQchnFtZldHUctGJjsgsyutUlu8vPq6yQ/132, createdBy=97862500016, createdName=ms3117646317107274, createdTime=Thu Nov 26 03:44:09 CST 2020, time=2020-11-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1709375, encodeId=98951e09375e8, content=<a href='/topic/show?id=bf4e514e25b' target=_blank style='color:#2F92EE;'>#心脏复律#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=51472, encryptionId=bf4e514e25b, topicName=心脏复律)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=hb2008ye, createdTime=Fri Jun 19 03:44:09 CST 2020, time=2020-06-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2032432, encodeId=058f20324324d, content=<a href='/topic/show?id=dd32514e318' target=_blank style='color:#2F92EE;'>#心脏复律除颤器#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=51473, encryptionId=dd32514e318, topicName=心脏复律除颤器)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=cfa576, createdName=wfang545, createdTime=Mon Oct 12 01:44:09 CST 2020, time=2020-10-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1748754, 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CST 2020, time=2020-03-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1373476, encodeId=5dce13e347687, content=<a href='/topic/show?id=2fd051939ab' target=_blank style='color:#2F92EE;'>#心衰患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=51939, encryptionId=2fd051939ab, topicName=心衰患者)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=467c360, createdName=yuanming7, createdTime=Mon Mar 30 02:44:09 CST 2020, time=2020-03-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1439169, encodeId=84bf14391692a, content=<a href='/topic/show?id=8e3a98396f2' target=_blank style='color:#2F92EE;'>#除颤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=98396, encryptionId=8e3a98396f2, topicName=除颤)], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyheQLjPSX3OUs5GmkyBlcCOwTPIeq3why9NGibxxUqYo6hcx8qZLHZFgNPnBK1yzWeOFpyg2OnWOt0/0, createdBy=fa4716, createdName=zhouqu_8, createdTime=Mon Mar 30 02:44:09 CST 2020, time=2020-03-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1520666, encodeId=6ed2152066683, content=<a href='/topic/show?id=7a736264553' target=_blank style='color:#2F92EE;'>#植入#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=62645, encryptionId=7a736264553, topicName=植入)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=832411313664, createdName=jiyangfei, createdTime=Mon Mar 30 02:44:09 CST 2020, time=2020-03-30, status=1, ipAttribution=)]
  9. 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beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=51472, encryptionId=bf4e514e25b, topicName=心脏复律)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=hb2008ye, createdTime=Fri Jun 19 03:44:09 CST 2020, time=2020-06-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2032432, encodeId=058f20324324d, content=<a href='/topic/show?id=dd32514e318' target=_blank style='color:#2F92EE;'>#心脏复律除颤器#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=51473, encryptionId=dd32514e318, topicName=心脏复律除颤器)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=cfa576, createdName=wfang545, createdTime=Mon Oct 12 01:44:09 CST 2020, time=2020-10-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1748754, encodeId=5f071e487546a, content=<a href='/topic/show?id=4087626564c' target=_blank style='color:#2F92EE;'>#植入式#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=62656, encryptionId=4087626564c, topicName=植入式)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=cdca36191722, createdName=villahu, createdTime=Mon Jun 08 01:44:09 CST 2020, time=2020-06-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1256754, encodeId=f7861256e54de, content=<a href='/topic/show?id=43706900963' target=_blank style='color:#2F92EE;'>#生存率#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=69009, encryptionId=43706900963, topicName=生存率)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=6a6043, createdName=guoyibin, createdTime=Mon Mar 30 02:44:09 CST 2020, time=2020-03-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1373476, encodeId=5dce13e347687, content=<a href='/topic/show?id=2fd051939ab' target=_blank style='color:#2F92EE;'>#心衰患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=51939, encryptionId=2fd051939ab, topicName=心衰患者)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=467c360, createdName=yuanming7, createdTime=Mon Mar 30 02:44:09 CST 2020, time=2020-03-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1439169, encodeId=84bf14391692a, content=<a href='/topic/show?id=8e3a98396f2' target=_blank style='color:#2F92EE;'>#除颤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=98396, encryptionId=8e3a98396f2, topicName=除颤)], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyheQLjPSX3OUs5GmkyBlcCOwTPIeq3why9NGibxxUqYo6hcx8qZLHZFgNPnBK1yzWeOFpyg2OnWOt0/0, createdBy=fa4716, createdName=zhouqu_8, createdTime=Mon Mar 30 02:44:09 CST 2020, time=2020-03-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1520666, encodeId=6ed2152066683, content=<a href='/topic/show?id=7a736264553' target=_blank style='color:#2F92EE;'>#植入#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=62645, encryptionId=7a736264553, topicName=植入)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=832411313664, createdName=jiyangfei, createdTime=Mon Mar 30 02:44:09 CST 2020, time=2020-03-30, status=1, ipAttribution=)]
    2020-03-30 zhouqu_8
  10. 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    2020-03-30 jiyangfei

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