心脏再同步和死于渐进性心力衰竭:随机对照试验的元分析
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
概括
心脏再同步治疗显著降低了渐进性心力衰竭的死亡率. 这种基于起器的治疗也降低了心力衰竭在患有左心室功能障碍的患者住院的数量.
科学领域:
- 心脏病学 心脏病学
- 医疗器械 医疗器械
- 临床试验 临床试验
背景情况:
- 渐进性心力衰竭是晚期病例的主要死亡原因.
- 心脏再同步治疗 (CRT) 可以改善心脏功能和生活质量.
- 在这项研究之前,CRT对死亡率的影响仍然不确定.
研究的目的:
- 评估心脏再同步在减少渐进性心力衰竭死亡率方面的有效性.
- 确定CRT是否影响整体死亡率和心力衰竭住院治疗.
主要方法:
- 一项对4项随机对照试验 (RCT) 的元分析,涉及1634名患者.
- 在多个数据库 (MEDLINE,EMBASE,Cochrane) 和临床试验注册表中进行了搜索.
- 包括RCT专注于使用CRT治疗的慢性症状左心室功能障碍.
主要成果:
- 心脏再同步治疗可以将渐进性心力衰竭的死亡率降低51% (OR,0.49;95% CI,0.25-0.93).
- 通过CRT治疗,心力衰竭住院的病例减少了29% (OR,0.71;95% CI,0.53-0.96).
- 观察到降低全因死亡率的趋势,但对于非心力衰竭死亡率或心室节律失常而言,这一趋势在统计上并不显著.
结论:
- 心脏再同步疗法有效降低左心室功能障碍患者的渐进性心力衰竭死亡率.
- 对于患有晚期心力衰竭的患者来说,CRT提供了显著的好处,解决了主要的死亡原因.
- 该疗法还显示出在减少心力衰竭住院治疗的价值.
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