NEJM:非冠状动脉疾病引起的症状性收缩性心力衰竭预防性植入ICD并不会降低长期死亡率

2016-08-29 MedSci MedSci原创

已知冠状动脉疾病引起的症状性收缩性心力衰竭使用植入式心脏复律除颤器(ICD)治疗效果较好。然而,对于非冠状动脉疾病引起的收缩性心力衰竭预防性使用ICD的治疗效果主要来源于亚组分析。自里程碑式的ICD试验以来心脏衰竭的管理得到了很大的改善,现在很多患者接受心脏再同步治疗(CRT)。 在此随机对照试验中,共纳入了556名非冠心病引起的症状性心力衰竭(左室射血分数,≤35%)患者接受ICD,560

已知冠状动脉疾病引起的症状性收缩性心力衰竭使用植入式心脏复律除颤器(ICD)治疗效果较好。然而,对于非冠状动脉疾病引起的收缩性心力衰竭预防性使用ICD的治疗效果主要来源于亚组分析。自里程碑式的ICD试验以来心脏衰竭的管理得到了很大的改善,现在很多患者接受心脏再同步化治疗(CRT)。

在此随机对照试验中,共纳入了556名非冠心病引起的症状性心力衰竭(左室射血分数,≤35%)患者接受ICD,560名患者接受常规护理(对照组)。在这两组中,58%的患者接受CRT。主要研究结果是全因死亡。次要研究结果是心源性猝死和心血管死亡。

结果,中位随访67.6个月后,ICD组120名(21.6%)患者和对照组131名(23.4%)患者达到了主要结果(风险比,0.87;95%可信区间,0.68-1.12;P = 0.28)。ICD组24名(4.3%)患者发生了心源性死亡,对照组46名(8.2%)(风险比,0.50;95% CI,0.31-0.82;P = 0.005)。ICD组27名(4.9%)患者发生设备相关的感染,对照组20名(3.6%)(P = 0.29)。

总而言之,在这项试验中,对于非冠状动脉疾病引起的症状性心力衰竭的患者来说,与常规治疗相比,预防性植入ICD并不能显著降低长期全因死亡率。

原始出处:

Lars Køber, D.M.Sc., Jens J. Thune,  et al., Defibrillator Implantation in Patients with Nonischemic Systolic Heart Failure. NEJM, August 28, 2016DOI: 10.1056/NEJMoa1608029.

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    2017-05-16 yilong5287542
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    2016-09-25 1e10c84am36(暂无匿称)

    文章很好值得关注

    0

  4. 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createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzdAIB7UwTkHt6fQkBP8ictliaXtc5gCUmYdAW1sAETC2nhO3q6YjRHkUibyOCtP8ibmXNObTyd63A076/0, createdBy=d4111948983, createdName=1e10c84am36(暂无匿称), createdTime=Sun Sep 11 08:07:00 CST 2016, time=2016-09-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=112433, encodeId=a04111243396, content=很好,不错,以后会多学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzUn81b5CF5ibVPib8jWI92iciaxmqGHlwruOnK4SVZykd4iahqo1hicklIibyZoxm55X7EM8BW9eX1h1hQ2/0, createdBy=8aa81937526, createdName=李东泽, createdTime=Tue Sep 06 16:14:00 CST 2016, time=2016-09-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1252877, encodeId=827b12528e7bd, content=<a href='/topic/show?id=463230886b8' target=_blank 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    2016-09-14 青龙偃月

    学习了,赞一个!

    0

  5. 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    2016-09-14 青龙偃月

    学习了,赞一个!

    0

  6. [GetPortalCommentsPageByObjectIdResponse(id=1860466, encodeId=273a1860466bf, content=<a href='/topic/show?id=d064933e0b' target=_blank style='color:#2F92EE;'>#ICD#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=9337, encryptionId=d064933e0b, topicName=ICD)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=87f580, createdName=yilong5287542, createdTime=Tue May 16 16:11:00 CST 2017, time=2017-05-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2034756, encodeId=01292034e563c, content=<a href='/topic/show?id=69c910030635' target=_blank style='color:#2F92EE;'>#预防性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=100306, encryptionId=69c910030635, topicName=预防性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45b2276, 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GetPortalCommentsPageByObjectIdResponse(id=106895, encodeId=9a4c106895cb, content=值得学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=17, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=5e291719269, createdName=大旺旺, createdTime=Mon Aug 29 14:44:00 CST 2016, time=2016-08-29, status=1, ipAttribution=)]
    2016-09-11 1e10c84am36(暂无匿称)

    己拜读,受益匪浅

    0

  7. 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createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzdAIB7UwTkHt6fQkBP8ictliaXtc5gCUmYdAW1sAETC2nhO3q6YjRHkUibyOCtP8ibmXNObTyd63A076/0, createdBy=d4111948983, createdName=1e10c84am36(暂无匿称), createdTime=Sun Sep 11 08:07:00 CST 2016, time=2016-09-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=112433, encodeId=a04111243396, content=很好,不错,以后会多学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzUn81b5CF5ibVPib8jWI92iciaxmqGHlwruOnK4SVZykd4iahqo1hicklIibyZoxm55X7EM8BW9eX1h1hQ2/0, createdBy=8aa81937526, createdName=李东泽, createdTime=Tue Sep 06 16:14:00 CST 2016, time=2016-09-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1252877, encodeId=827b12528e7bd, content=<a href='/topic/show?id=463230886b8' target=_blank style='color:#2F92EE;'>#冠状动脉疾病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=30886, encryptionId=463230886b8, topicName=冠状动脉疾病)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=3f0227, createdName=howi, createdTime=Wed Aug 31 03:11:00 CST 2016, time=2016-08-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1520322, encodeId=33bf152032264, content=<a href='/topic/show?id=7a736264553' target=_blank style='color:#2F92EE;'>#植入#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=22, 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=Wed Aug 31 03:11:00 CST 2016, time=2016-08-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=106895, encodeId=9a4c106895cb, content=值得学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=17, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=5e291719269, createdName=大旺旺, createdTime=Mon Aug 29 14:44:00 CST 2016, time=2016-08-29, status=1, ipAttribution=)]
    2016-09-06 李东泽

    很好,不错,以后会多学习

    0

  8. 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createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzdAIB7UwTkHt6fQkBP8ictliaXtc5gCUmYdAW1sAETC2nhO3q6YjRHkUibyOCtP8ibmXNObTyd63A076/0, createdBy=d4111948983, createdName=1e10c84am36(暂无匿称), createdTime=Sun Sep 11 08:07:00 CST 2016, time=2016-09-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=112433, encodeId=a04111243396, content=很好,不错,以后会多学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzUn81b5CF5ibVPib8jWI92iciaxmqGHlwruOnK4SVZykd4iahqo1hicklIibyZoxm55X7EM8BW9eX1h1hQ2/0, createdBy=8aa81937526, createdName=李东泽, createdTime=Tue Sep 06 16:14:00 CST 2016, time=2016-09-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1252877, encodeId=827b12528e7bd, content=<a href='/topic/show?id=463230886b8' target=_blank 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  9. 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createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzdAIB7UwTkHt6fQkBP8ictliaXtc5gCUmYdAW1sAETC2nhO3q6YjRHkUibyOCtP8ibmXNObTyd63A076/0, createdBy=d4111948983, createdName=1e10c84am36(暂无匿称), createdTime=Sun Sep 11 08:07:00 CST 2016, time=2016-09-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=112433, encodeId=a04111243396, content=很好,不错,以后会多学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzUn81b5CF5ibVPib8jWI92iciaxmqGHlwruOnK4SVZykd4iahqo1hicklIibyZoxm55X7EM8BW9eX1h1hQ2/0, createdBy=8aa81937526, createdName=李东泽, createdTime=Tue Sep 06 16:14:00 CST 2016, time=2016-09-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1252877, encodeId=827b12528e7bd, content=<a href='/topic/show?id=463230886b8' target=_blank 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GetPortalCommentsPageByObjectIdResponse(id=106895, encodeId=9a4c106895cb, content=值得学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=17, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=5e291719269, createdName=大旺旺, createdTime=Mon Aug 29 14:44:00 CST 2016, time=2016-08-29, status=1, ipAttribution=)]
    2016-08-31 jiyangfei
  10. 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GetPortalCommentsPageByObjectIdResponse(id=106895, encodeId=9a4c106895cb, content=值得学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=17, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=5e291719269, createdName=大旺旺, createdTime=Mon Aug 29 14:44:00 CST 2016, time=2016-08-29, status=1, ipAttribution=)]
    2016-08-29 大旺旺

    值得学习

    0