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首页> 外文期刊>Open Heart >The 7-year teesside experience of primary prevention ICD indications following primary PCI (PPCI) and the potential impact of a change in NICE guidance
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The 7-year teesside experience of primary prevention ICD indications following primary PCI (PPCI) and the potential impact of a change in NICE guidance

机译：在原发性PCI（PPCI）之后进行原发性ICD适应证的7年teesside经验以及NICE指南变更的潜在影响

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Introduction The recovery of LV function in patients with severe LV impairment in the acute phase following primary percutaneous coronary intervention (PPCI) is not well established. The indication for a primary prevention ICD post-STEMI is dependent on which screening guidance, NICE or ESC, is followed. The potential impact of the new NICE guidance is estimated. Methods We performed a retrospective analysis of all patients presenting with a STEMI over a 7-year period (2005–2012) treated with PPCI to determine in-hospital mortality, LV function at index presentation, at 3 months and the predicted primary prevention ICD implantation rate using NICE (TA095) and ESC 2006 guidelines. Predicted implant rates using the new NICE guidance (TA314) and actual implantation rates were also assessed. Results 3902 patients with a mean age of 65±13 years underwent PPCI. Of those patients surviving until discharge, 332 (10%) had LVEF ≤35%. 254 of 332 patients (76%) with a severely impaired ventricle were followed up at participating centres. 210 of 254 (83%) patients had a repeat echocardiogram within 3 months post-MI; among these patients, 89 (42%) remained to have LVEF ≤35%. The number of patients fulfilling NICE and ESC criteria for primary prevention ICD implantation was 14 (16%) and 84 (94%), respectively. The actual number of patients receiving an ICD was 17 (19%). The number of patients fulfilling the new NICE (TA314) guidance was 84 (94%). Conclusions A small proportion of patients with STEMIs undergoing PPCI have a severely impaired LV systolic function. A large proportion of these patients will have improved LV systolic function at 3 months. There is a five-fold difference in the predicted ICD implantation rates depending on which guidance is followed—NICE versus ESC. The potential impact of the new NICE (TA314) guidance on ICD implantation will be a significant increase in ICD implantation rates.
机译：前言急性经皮冠状动脉介入治疗（PPCI）后急性期严重左室功能不全患者的左室功能恢复尚不充分。 STEMI后的一级预防ICD的适应症取决于遵循的筛查指南（NICE或ESC）。估计了新的NICE指南的潜在影响。方法我们对所有接受PPCI治疗7年（2005-2012年）中STEMI的患者进行了回顾性分析，以确定3个月时住院时的死亡率，指数表现时的LV功能以及预计的一级预防ICD植入使用NICE（TA095）和ESC 2006指南进行费率计算。还评估了使用新的NICE指南（TA314）预测的植入率和实际植入率。结果3902例平均年龄为65±13岁的患者接受了PPCI。存活至出院的患者中，332（10％）的LVEF≤35％。在332例严重心室受损的患者中，有254例在参与中心接受了随访。 254例患者中有210例（83％）在心梗后3个月内进行了超声心动图检查;在这些患者中，仍有LVEF≤35％的患者89例（42％）。符合NICE和ESC标准的一级预防ICD植入的患者人数分别为14（16％）和84（94％）。接受ICD的患者实际人数为17（19％）。符合新的NICE（TA314）指南的患者人数为84（94％）。结论接受PPCI的STEMI患者中，有一小部分患有严重的LV收缩功能受损。这些患者中的很大一部分将在3个月时改善左室收缩功能。根据所遵循的指南（NICE与ESC），预计的ICD植入率存在五倍的差异。新的NICE（TA314）指南对ICD植入的潜在影响将是ICD植入率的显着提高。

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