在接受植入式心脏转换器除器或心脏再同步治疗脉冲发生器替换的患者的一年死亡率:识别有风险的患者
Michelle Feijen1, Anastasia D Egorova1, Teresa Kuijken1
1Department of Cardiology, Leiden Heart-Lung Center, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands.
Journal of clinical medicine
|September 9, 2023
概括
需要除器 (ICD) 或CRT-D脉冲发生器更换的患者面临更高的死亡风险,特别是CRT-D.识别高风险个体对于对设备寿命和患者护理的明智决策至关重要.
科学领域:
- 心脏病学 心脏病学
- 医疗器械 医疗器械
- 公共卫生 公共卫生
背景情况:
- 植入式心脏转移器除器 (ICD) 和具有除器功能的心脏再同步治疗 (CRT-D) 对于预防心脏突然死亡至关重要.
- 缺乏指导方针来识别不太可能从ICD或脉冲发生器交换中受益的患者.
- 需要个性化风险分层来优化设备管理和患者的结果.
研究的目的:
- 为了调查接受ICD或CRT-D脉冲发生器更换的患者的1年死亡率.
- 为了确定与设备交换后死亡率相关的患者和程序相关因素.
- 评估风险评分的必要性,以指导有关设备更换的共同决策.
主要方法:
- 在第三级医院接受ICD或CRT-D脉冲发生器更换的588名患者 (2018-2021) 的回顾性分析.
- 死亡原因和患者/程序相关因素的分层.
- 对1年全因死亡率的预测值的评估.
主要成果:
- 与ICD交换 (2.8%) 相比,CRT-D替换 (10.7%) 和升级 (11.9%) 的1年全因死亡率明显高.
- 一年死亡率的独立预测因素包括LVEF≤30%,NYHA类≥3,eGFR≤30mL/min/m2,以及血红蛋白≤7mmol/L.
- 在研究人群中,轻微减少的LVEF是常见的 (37%).
结论:
- CRT-D 替换/升级与比 ICD 更换更高的死亡率有关.
- 特定的临床因素预测脉冲发生器更换后的短期死亡率.
- 需要前性验证的风险评分来支持设备更换的共享决策.
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