心臓再同期と進行性心不全による死亡:ランダム化対照試験のメタ分析

David J Bradley¹, Elizabeth A Bradley, Kenneth L Baughman

¹Division of Cardiology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Md, USA. DBradley@jhmi.edu

JAMA

|February 15, 2003

まとめ

心臓再同期療法により,進行性心不全による死亡率が著しく低下します. このペースメーカーベースの治療は,左心室機能不全の患者の心不全の入院率も低下させます.

科学分野:

心臓病学心臓病学
医療機器医療機器について
クリニック・トライアル臨床試験

背景:

進行性心不全は,進行した症例における主要な死因です.
心臓再同期療法 (CRT) は,心臓の機能と生活の質を改善します.
CRTが死亡率に与える影響は,この研究の前に不確実であった.

研究の目的:

進行性心不全による死亡率を下げるための心臓再同期の有効性を評価する.
CRTが全死亡率と心不全の入院に影響を及ぼすかどうかを判断する.

主な方法:

1634人の患者が参加した4つのランダム化比較試験 (RCT) のメタ解析.
複数のデータベース (MEDLINE,EMBASE,Cochrane) と臨床試験登録簿で検索しました.
CRTで治療された慢性症状の左心室機能不全に焦点を当てたRCTが含まれています.

主要な成果:

心臓再同期療法は,進行性心不全による死亡率を51% (OR,0.49;95%CI,0.25-0.93) 減少させた.
CRTは心不全の入院を29%減少させた (OR,0.71;95%CI,0.53-0.96).
すべての原因による死亡率の減少への傾向が観察されましたが,心不全以外の死亡率や心室不律症では統計的に有意ではありませんでした.

結論:

心臓再同期療法は,左心室機能不全の患者の進行性心不全による死亡率を低減するのに効果的です.
CRTは,進行性心不全の患者にとって,死亡の主な原因に対処することで,大きな利点をもたらします.
この治療は,心不全による入院を減らす価値も示しています.

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