- 作者：Alon Barsheshet ; MD ; alon.barsheshet@heart.rochester.edu ; Arthur J. Moss ; MD ; David T. Huang ; MD ; Scott McNitt ; MSc ; Wojciech Zareba ; MD ; PhD ; Ilan Goldenberg ; MD
- 关键词：implantable cardioverter-defibrillator ; mortality ; risk stratification
- 刊名：Journal of the American College of Cardiology
- 出版年：2012
- 期刊代码：201_07351097
- 类别：med
- 出版时间：5 June, 2012
- 卷：59
- 期：23
- 页码：2075-2079
- 文件大小：817 K
Objectives
The present study was designed to explore the 8-year survival benefit of a nonresynchronization implantable cardioverter-defibrillator (ICD) according to a simple risk stratification score.Background
There is limited information regarding factors that predict the benefit of primary prevention with an ICD during long-term follow-up.
Methods
This study used a previously developed risk score including 5 clinical factors (New York Heart Association functional class >II, age >70 years, blood urea nitrogen >26 mg/dl, QRS duration >0.12 s, and atrial fibrillation) to evaluate 8-year ICD survival benefit within risk score categories among 1,191 MADIT-II (Multicenter Automatic Defibrillator Implantation Trial II) patients.
Results
Patients with low (0 risk factors, n = 345) and intermediate risk (1 to 2 risk factors, n = 646) demonstrated a significantly higher probability of survival at 8-year follow-up when treated by ICD as compared with non-ICD therapy (75%vs. 58%, p = 0.004; and 47%vs. 31%, p < 0.001, respectively). By contrast, among high-risk patients (3 or more risk factors, n = 200), there was no significant difference in 8-year survival between the ICD and non-ICD subgroups (19%vs. 17%, p = 0.50). Consistently, multivariate analysis showed that ICD therapy was associated with a significant long-term survival benefit among low- and intermediate-risk patients (hazard ratio [HR]: 0.52, p < 0.001, and HR: 0.66, p < 0.001, respectively), whereas treatment with an ICD was not associated with a significant benefit among high-risk patients (HR: 0.84, p = 0.25).
Conclusions
These findings suggest that a simple risk score can identify patients who derive significant long-term benefit from primary ICD therapy. High-risk patients with multiple comorbidities composed 17%of the MADIT-II population and did not derive long-term benefit from nonresynchronization device therapy.