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Circulation:植入式心律转复除颤器在预防透析患者心脏性猝死中的应用

2019-03-29 xiangting MedSci原创

在经过充分筛选和良好治疗的透析患者中,预防性ICD疗法并未降低SCD或全因死亡率,该人群的SCD和全因死亡率仍然很高。

据报道接受透析的终末期肾病患者心脏性猝死(SCD)的风险高,并且迄今为止,没有任何治疗方法可以有效降低这种风险。预防性植入式心律转复除颤器(ICD)预防SCD的可行性和价值尚不确定。

研究人员进行了ICD2试验,这是一项前瞻性随机对照研究,在对其他治疗进行充分筛选和优化后,分析了200例左心室射血分数≥35%的透析患者植入ICD预防SCD的价值和安全性。主要终点是SCD。次要终点是全因死亡率和ICD相关并发症。

根据数据和安全监测委员会无效原因的建议,在纳入188例患者后试验停止,ICD组97例患者,对照组91例。中位随访时间为6.8年(四分位间距,3.8-8.8)。19/188例患者(10.1%)发生SCD,ICD组11/97例,对照组8/91例。ICD组的5年累积SCD发病率为9.7%(95%置信区间[CI],3.3-16.2%),对照组为7.9%(95%CI,1.7-14.0%),风险比(HR)为1.32(95%CI,0.53 - 3.29,P= 0.55)。总体而言,99/188例患者死亡(52.7%),ICD组52/97例,对照组47/91例。ICD组的5年生存率为50.6%(95%CI,39.8-61.5%),对照组为54.5%(95%CI,43.0-66.0%),HR为1.02(95%CI,0.69-1.52,P=0.92)。接受ICD的80例患者中,发生了25例ICD植入相关不良事件。

在经过充分筛选和良好治疗的透析患者中,预防性ICD疗法并未降低SCD或全因死亡率,该人群的SCD和全因死亡率仍然很高。

原始出处:

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    2020-01-01 villahu
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    2019-03-31 zhouqu_8
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    2019-03-31 jiyangfei
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