在心肌梗塞后死亡风险和除器效益的时间依赖性
David J Wilber1, Wojciech Zareba, W Jackson Hall
1Cardiovascular Institute, Loyola University Medical Center, Maywood, Ill 60153, USA. dwilber@lumc.edu
Circulation
|March 3, 2004
概括
植入式除器 (ICD) 改善了心脏病发作幸存者的存活率,减少了喷射分数. 对于远程心肌梗塞 (MIs),ICDs的生存益处更大,持续超过15年.
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:
- 预防性植入式除器 (ICD) 用于心肌梗塞 (MI) 后心室功能受损的患者.
- 自心脏病发作以来的时间对死亡风险和ICD生存益处的影响尚未得到充分证实.
研究的目的:
- 调查后心脏病发作患者的预防性内科疾病的死亡风险和生存益处是否取决于心肌梗塞发生以来的时间.
- 分析接受ICD与传统护理的患者中心脏病发作时间和死亡率之间的关系.
主要方法:
- 从多中心自动除器植入试验II (MADIT II) 的数据分析.
- 包括1159名患有射出分数<=30%后心脏病发作的患者,随机分配到ICD或常规护理.
- 死亡率是根据MI (<18,18-59,60-119,>=120个月) 的四分位数分析的.
主要成果:
- 传统护理组的死亡率随着时间的推移从心脏病发作 (7.8%至14.0%) 增加.
- 在所有时间区 (7.2%,4.9%,8.2%,9.0%) 中,ICD患者的死亡率始终较低.
- 与最近的MI (<18个月) (0.97) 相比,ICDs死亡的调整后危险比率在远程MI (>=18个月) (0.55) 和近期MI (0.97) 中显著较低.
结论:
- 随着时间的推移,心脏病发作后患者的死亡风险,射出分数<=30%,会增加.
- ICDs的生存优势在患有远程MIs的患者中更为明显.
- 在心肌梗塞发作后,ICD疗法可提供长达15年或更长时间的生存益处.
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