在没有先前适当的植入式心脏转换器-除器治疗的情况下死亡:一个竞争性风险研究
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
概括
对于接受植入式心脏变压器 (ICD) 的患者来说,在接受治疗之前死亡的风险是显著的,特别是在晚期心力衰竭患者中. 谨慎的患者选择对于最大限度地提高ICD的益处至关重要.
科学领域:
- 心脏病学 心脏病学
- 医疗器械 医疗器械
- 临床研究 临床研究
背景情况:
- 已证实可植入式心脏转换器-除器 (ICD) 在特定心力衰竭人群中可以改善存活率.
- 然而,在常规护理中,在ICD治疗前死亡等竞争风险可能会限制益处.
研究的目的:
- 在当代患者队列中评估没有适当的ICD治疗的情况下死亡的风险.
- 为了确定ICD治疗与没有治疗的死亡的预测因素.
主要方法:
- 一个单一中心的前性注册表分析442名患有缺血性或扩张性心肌病的患者接受ICD (1994-2006).
- 竞争性风险回归被用于分析首次适当的ICD治疗或在没有先前治疗的情况下死亡的时间.
主要成果:
- 在平均3.6年的时间里,52%的患者接受了适当的ICD治疗,11%的患者没有接受ICD治疗就死亡.
- 23%的人没有接受心室动治疗就死亡,而接受这种治疗的人为13%.
- 在ICD治疗前,用于心力衰竭的利尿剂预测死亡风险增加4倍.
结论:
- 当代患者在没有先前适当的ICD治疗的情况下存在相当大的死亡风险.
- 这种风险在患有晚期心力衰竭的患者中特别高,这强调了需要仔细选择患者的必要性.
相关概念视频
Cardiomyopathy II: Dilated Cardiomyopathy
Dilated cardiomyopathy, or DCM, is a progressive myocardial disorder characterized by ventricular chamber dilation and contractile dysfunction.EtiologyVarious factors can cause DCM, including hypertension and heavy alcohol intake, which contribute to the weakening and enlargement of the heart muscle. Viral infections, such as Coxsackievirus B, adenoviruses, and influenza, can lead to DCM by causing inflammation and damage to heart tissue. Certain chemotherapeutic agents, including daunorubicin,...
Cardiomyopathy V: Interprofessional Care
Managing cardiomyopathy involves addressing underlying or precipitating causes, treating heart failure with medications, and implementing dietary changes and a balanced exercise and rest regimen.Lifestyle ModificationsCardiomyopathy patients should adopt a low-sodium diet to reduce fluid retention and manage heart failure. A personalized exercise and rest plan helps maintain physical fitness without overstraining the heart. Avoiding alcohol and tobacco is essential to prevent further damage to...
Cardiopulmonary Resuscitation III: AED Use
Introduction to AEDAn Automated External Defibrillator (AED) is a portable medical device that analyzes the heart's rhythm and, if necessary, delivers an electrical shock to help the heart re-establish an effective rhythm during sudden cardiac arrest (SCA). SCA occurs when the heart suddenly and unexpectedly stops beating, leading to a loss of blood flow to the brain and other vital organs. In such emergencies, time is of the essence, and using an AED, combined with Cardiopulmonary...
Acute Coronary Syndrome III: Diagnostic Studies
Diagnosing acute coronary syndrome or ACS begins with a thorough patient history. Notable symptoms include central, crushing chest pain radiating to the left arm, neck, jaw, or back, along with shortness of breath, sweating (diaphoresis), nausea, vomiting, dizziness, and palpitations.It is crucial to note any history of cardiac illnesses and assess risk factors, including age, gender, smoking, hypertension, diabetes, hyperlipidemia, and a sedentary lifestyle.During physical examination, vital...
Cardiomyopathy III: Hypertrophic Cardiomyopathy
Hypertrophic cardiomyopathy, or HCM, is an autosomal dominant genetic disorder characterized by asymmetric left ventricular hypertrophy without ventricular dilation. It is more common in men and is typically diagnosed in young, athletic adults.EtiologyHCM is primarily genetic and is caused by mutations in genes encoding sarcomeric proteins. Researchers have identified over 1400 mutations across at least 11 different genes. Among these, the most frequently occurring mutations are found in the...
Heart Failure VI: Adjunct Therapies
Additional therapies for treating patients with heart failure (HF) may include procedural interventions, supplemental oxygen, the management of sleep disorders, and nutritional therapy.Procedural InterventionsImplantable Cardioverter-Defibrillator: For patients at risk of life-threatening arrhythmias due to severe left ventricular dysfunction, an Implantable Cardioverter-Defibrillator (ICD) can detect and terminate these arrhythmias, preventing sudden cardiac death and improving survival rates.

