伴随性疾病和对心脏再同步治疗的临床反应:来自八项临床试验的患者级元分析
Marat Fudim1,2,3, Frederik Dalgaard1,4,5, Daniel J Friedman1,2
1Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA.
European journal of heart failure
|September 6, 2023
概括
心脏再同步治疗 (CRT) 有效地减少心力衰竭住院和死亡率,即使在患有多种并存疾病的患者中也是如此. 这种疗法在不同的并发症负担中被证明是有益的.
科学领域:
- 心脏病学 心脏病学
- 心脏衰竭管理的管理
- 临床试验 临床试验
背景情况:
- 患有心力衰竭 (HF) 的患者经常出现多种并发症,使治疗疗效复杂化.
- 调查并发症负担对心脏再同步治疗 (CRT) 的有效性的影响对于个性化高压管理至关重要.
研究的目的:
- 确定伴随性疾病的数量是否会影响心力衰竭患者对心脏再同步治疗 (CRT) 的临床反应.
- 分析CRT对不同并发症层死亡率和心力衰竭住院 (HFH) 的影响.
主要方法:
- 从八项随机对照试验 (RCT) 的患者级数据进行了汇总,其中包括CRT与没有CRT.
- 评估的并发症包括心房动,冠状动脉疾病,糖尿病和高血压.
- 患者根据并发症计数 (0,1-2或≥3) 分类为不同组,并使用贝叶斯分层维布尔生存回归分析.
主要成果:
- 总共分析了6324名患者,其中21%的人患有三种或更多的并发症.
- 在整体队列中,CRT显著降低了全因死亡率 (aHR 0.79) 和高血压或全因死亡率 (aHR 0.74) 的复合终点.
- 在所有并发症组中都观察到这些好处,在任何终点上,CRT和并发症负担之间没有统计学上显著的相互作用.
结论:
- 心脏再同步疗法 (CRT) 在减少心力衰竭住院和/或全因死亡率方面表现出有效性.
- 即使在患有大量并发性疾病的患者中,CRT的积极影响也会持续下去.
- 来自这次元分析的证据支持在心力衰竭患者中使用CRT,无论他们的并发症负担如何.
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