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首页> 外文期刊>Acta Cardiologica >Implantable cardioverter/defibrillator interventions in primary prevention: do current implantation criteria really predict ICD interventions?
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Implantable cardioverter/defibrillator interventions in primary prevention: do current implantation criteria really predict ICD interventions?

机译：一级预防中的植入式心脏复律器/除颤器干预：目前的植入标准是否真的可以预测ICD干预？

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BACKGROUND: Randomized controlled trials have proven the efficacy of implantable cardioverter/defibrillators (ICDs) to prevent sudden cardiac death (SCD) in primary prevention. However,long-term data on the incidence of appropriate and inappropriate interventions in real life and on the predictive value of commonly used clinical variables to guide patient selection are scarce. METHODS: We retrospectively studied 101 patients who received an ICD for primary prophylaxis of SCD: 63.4% with ischaemic heart disease (IHD) and 36.6% with idiopathic dilated cardiomyopathy (IDCM). The mean follow-up period was 26.2 (+/- 14.8; median 27.8; range 5.6-70.5) months. Age, left ventricular ejection fraction (LVEF), QRS duration, NYHA class and electrophysiological study (EPS) outcome were evaluated as predictors of ICD intervention. RESULTS: At 2 years the cumulative incidence of appropriate (17.5% in IHD; 28% in IDCM; P= 0.63) and inappropriate (12.8% in IHD, 15.4% in IDCM; P = 0.62) interventions was similar in both groups. Atrial fibrillation was the most common cause of inappropriate interventions in the IHD group, sinus tachycardia in the IDCM group. Advanced age was associated with less inappropriate interventions (HR: 0.96 (95% confidence interval (CI) 0.94-0.98); P < 0.01), and a better LVEF with less appropriate interventions (HR: 0.97 (95% Cl 0.94-0.99); P < 0.01). This amounted in a significant absolute difference in the number of appropriate interventions between the group with a LVEF < 25% and 25-34% after 3 years of follow-up of 42% in IHD (48% vs 6%). A prolonged QRS duration was associated with a slightly elevated risk for appropriate interventions only in the IHD group (HR: 1.01 (95% CI 1.00-1.03); P = 0.04). On the other hand, increased NYHA class was only associated with increased risk for appropriate interventions in the IDCM group (HR: 5.24 (95% CI1.11-24.74); P= 0.04). No significant statistical association was found between a positive EPS and appropriate or inappropriate interventions. CONCLUSIONS: In primary prevention, during a mean follow-up of 2 years, one in five patients had a possibly live-saving appropriate intervention. However, the incidence of inappropriate interventions was substantial. Predictors for appropriate interventions were: (i) LVEF in the total study group, (ii) NYHA class in the IDCM group and (iii) QRS duration in the IHD group.
机译：背景：随机对照试验已证明植入式心脏复律器/除颤器（ICD）在一级预防中预防心脏性猝死（SCD）的功效。但是，缺乏关于现实生活中适当和不适当干预的发生率以及指导患者选择的常用临床变量的预测价值的长期数据。方法：我们回顾性研究了接受ICD预防SCD的101例患者：缺血性心脏病（IHD）占63.4％，特发性扩张型心肌病（IDCM）占36.6％。平均随访期为26.2（+/- 14.8;中位数27.8;范围5.6-70.5）月。年龄，左心室射血分数（LVEF），QRS持续时间，NYHA分级和电生理研究（EPS）结果被评估为ICD干预的预测指标。结果：在2年时，两组的适当干预（IHD占17.5％; IDCM占28％; P = 0.63）和不适当（IHD占12.8％，IDCM占15.4％; P = 0.62）的累积发生率两组相似。房颤是IHD组不适当干预的最常见原因，IDCM组是窦性心动过速。高龄与较少的不适当干预有关（HR：0.96（95％置信区间（CI）0.94-0.98）; P <0.01），以及较高的LVEF和较少的适当干预（HR：0.97（95％Cl 0.94-0.99） ; P <0.01）。 IHD随访42年后，LVEF <25％和25-34％的组之间进行适当干预的数量之间存在显着的绝对差异（48％vs 6％）（3年随访）。仅在IHD组中，QRS持续时间延长与适当干预的风险略有升高相关（HR：1.01（95％CI 1.00-1.03）; P = 0.04）。另一方面，在IDCM组中，增加NYHA等级仅与采取适当干预措施的风险增加相关（HR：5.24（95％CI1.11-24.74）; P = 0.04）。 EPS阳性与适当或不适当的干预措施之间没有发现显着的统计学关联。结论：在一级预防中，平均随访2年，五分之一的患者接受了可能挽救生命的适当干预。但是，不适当干预的发生率很高。适当干预的预测因素包括：（i）整个研究组的LVEF，（ii）IDCM组的NYHA等级和（iii）IHD组的QRS持续时间。

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