在241名植入式心脏转换器-除器治疗患者中,发生冲击和存活率
W Grimm1, B T Flores, F E Marchlinski
1Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia.
Circulation
|June 1, 1993
概括
临床因素影响植入式心脏转换器-除器 (ICD) 冲击时间和存活率. 低射出分数可以预测冲击和死亡率,但ICD治疗有效地预防高风险患者的突然心脏死亡.
科学领域:
- 心脏病学 心脏病学
- 电子生理学 电子生理学
- 医疗器械 医疗器械
背景情况:
- 植入式心脏转换器-除器 (ICD) 对于管理危及生命的心律失常至关重要.
- 了解影响ICD冲击发生和患者生存的因素对于优化治疗至关重要.
研究的目的:
- 研究临床特征对接受ICD治疗的患者中冲击发生率和存活率的影响.
- 为了确定这种高风险人群中休克发生和死亡率的预测因素.
主要方法:
- 在1982年至1991年间对241名接受ICD植入的患者进行了分析.
- 平均26个月的随访,以评估适当和自发冲击的精算发病率.
- 评估临床变量,包括左心室喷射分数,呈现症状,以及手术前的电生理学测试,作为预测结果.
主要成果:
- 在5年内,适当冲击的精算发病率达到63%,任何自发冲击的发病率达到76%.
- 较差的左心室功能 (排泄分数≤30%) 与较早发生的冲击发生有显著的关联 (p=0.001).
- 射出分数≤30%是心律失常死亡和总死亡率 (分别为p=0.019和p=0.003) 的最强预测因素.
结论:
- 大多数患者在长期随访期间会经历冲击,但这与死亡率的增加无关,这表明有效预防心脏突然死亡.
- 低射出分数是对冲击发生和死亡率的关键预测因素.
- 根据目前的临床特征,预测哪些患者将从ICD植入中获益最大仍然具有挑战性.
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