前もって適切なインプラント可能な心臓変容器-除細動器療法なしで死亡:競合するリスク研究
Michael T Koller1, Beat Schaer, Marcel Wolbers
1University Hospital Basel, Basel Institute for Clinical Epidemiology, CH-4031 Basel, Switzerland. kollerm@uhbs.ch
Circulation
|April 9, 2008
まとめ
埋め込み式心動除細動器 (ICD) を投与している患者では,治療を受ける前に死亡するリスクが高く,特に心不全が進行している患者では高い. ICDの恩恵を最大化するために,慎重に患者の選択することが重要です.
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・リサーチ 臨床研究
背景:
- 植入可能な心臓変容器-除細動器 (ICD) は,特定の心不全集団における生存率を改善することが証明されています.
- しかし,日常的なケアでは,ICD治療の前に死亡するなどの競合するリスクが,効果を制限する可能性があります.
研究 の 目的:
- 現代の患者コホートにおける適切なICD治療なしで死亡するリスクを評価する.
- ICD治療と治療なしでの死亡の予測要因を特定する.
主な方法:
- 単一センターのプロスペクティブ・レジスタリ分析で,ICDを投与された,不全性または拡張性心筋症の442人の患者 (1994年-2006年) を対象とした.
- 競合するリスク回帰は,最初の適切なICD治療または事前治療なしで死亡までの時間を分析するために使用されました.
主要な成果:
- 平均3.6年間で,52%が適切なICD治療を受け,11%がそれなしに死亡しました.
- 23%が心房細動の治療を受けずに死亡し,その治療を受けた13%と比較した.
- 心不全の利尿剤の使用は,ICD治療の前に死亡のリスクが4倍増加することを予測しました.
結論:
- 適切なICD治療を前もって行わなければ,現代の患者では死亡のリスクがかなりあります.
- このリスクは,特に進行した心不全の患者に高くなっており,慎重に患者を選択する必要性を強調しています.
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