摘要
目的对比心脏性猝死(SCD)一级和二级预防患者植入埋藏式心脏转复除颤器(ICD)术后生存与适当治疗的情况。方法连续入选于本院行ICD或带除颤功能的心脏再同步治疗(CRT-D)植入术的患者,随访记录患者的生存情况、ICD保存的室性心律失常与治疗数据,对比一级预防与二级预防组间生存与ICD适当治疗,并寻找ICD术后生存和ICD适当治疗的预测因素。结果入选124例患者,一级预防组63例,二级预防组61例,中位随访时间300天。共有12例患者死亡(9.6%),其中一级预防组7例(11.1%),二级预防组5例(8.2%),组间生存曲线无统计学差异(P=0.095)。术前log(NT-proBNP)是术后生存的唯一独立预测因素(HR=8.81,P=0.047)。共有24例患者接受过ICD适当治疗(19.4%),组间术后ICD适当治疗曲线存在显著差异(P=0.014)。QRS波时限(QRSd)是术后ICD适当治疗的独立预测因素(HR=1.24,P=0.020)。QRSd≥120 ms的患者中二级预防组患者更早接受ICD适当治疗(P=0.027),QRSd<120 ms的患者中组间首次ICD适当治疗时间无差异(P=0.242)。结论因SCD一级预防与二级预防植入ICD患者在术后生存无显著差异;二级预防较一级预防患者更早接受ICD适当治疗,这种差异主要归因于术前QRSd≥120 ms的患者。
Objective To compare survival and appropriate therapy between patients undergoing cardioverter defibrilla- tor implantation for primary and secondary prevention of sudden cardiac death （SCD）. Methods Patients undergoing implantation of implanted cardioverter defibrillator （ICD） or cardiac resynchronization therapy with defibrillator function （CRT-D） were consecutively recruited, and were divided into two groups based on the prevention of SCD. Survival and ap- propriate therapy were recorded and compared between groups, with assessment of predictors of survival and appropriate therapy after ICD implantation. Results A total numbers of 124 patients were enrolled, including 63 for primary and 61 for secondary prevention. There was no significant difference in survival curve （P = 0.095） between the two groups. More patients of secondary prevention received appropriate therapies （7.9% vs 31.2%, P 〈 0.01 ）, and there was significant difference in appropriate therapy curve between the two groups （P = 0. 014）. NT-proBNP level was the only predictor of survival（HR = 8.81, P = 0. 047 ） and QRSd for appropriate therapy after ICD implantation （ HR = 1.24, P = 0. 020） re- spectively. Patients of secondary prevention received earlier appropriate therapy in the subgroup of QRS duration （QRSd） ≥ 120 ms（P = 0.027）, while there was no difference in the subgroup of QRSd 〈 120 ms（P = 0.242）. ConclusionsThere is no difference in survival between patients of card- ioverter defibrillator implantation for primary and secondary prevention of SCD; patients treated for secondary preven- tion receive earlier appropriate therapy, which is more contributed by patients with QRSd ≥ 120 ms before implan- tation.
出处
《中国心脏起搏与心电生理杂志》
2012年第6期481-484,共4页
Chinese Journal of Cardiac Pacing and Electrophysiology
关键词
心血管病学
埋藏式心脏转复除颤器
心脏性猝死
生存分析
适当治疗
rdiology
Implanted cardioverter defibrillator
Sudden cardiac death
Survival analysis
Appropriate therapy
