Predicting appropriate shocks in patients with heart failure: Patient levelmeta-analysis from SCD-HeFT and MADIT II

被引：22

作者：

Zeitler, Emily P. ^{[1
]}

Al-Khatib, Sana M. ^{[1
,2
]}

Friedman, Daniel J. ^{[1
,2
]}

Han, Joo Yoon ^{[3
]}

Poole, Jeanne E. ^{[3
]}

Bardy, Gust H. ^{[3
]}

Bigger, J. Thomas ^{[4
]}

Buxton, Alfred E. ^{[6
]}

Moss, Arthur J. ^{[5
]}

Lee, Kerry L. ^{[2
]}

Dorian, Paul ^{[7
]}

Cappato, Riccardo ^{[8
,9
]}

Kadish, Alan H. ^{[10
]}

Kudenchuk, Peter J. ^{[3
]}

Mark, Daniel B. ^{[1
,2
]}

Inoue, Lurdes Y. T. ^{[3
]}

Sanders, Gillian D. ^{[2
]}

机构：

[1] Duke Univ Hosp, Durham, NC USA

[2] Duke Clin Res Inst, Duke Box 3485,7020 North Pavil Bldg, Durham, NC 27710 USA

[3] Univ Washington, Seattle, WA 98195 USA

[4] Columbia Univ, New York, NY USA

[5] Univ Rochester, Rochester, NY USA

[6] Beth Israel Deaconess Med Ctr, Boston, MA 02215 USA

[7] Univ Toronto, Toronto, ON, Canada

[8] Humanitas Univ, Milan, Italy

[9] Humanitas Clin Res Inst, Milan, Italy

[10] Northwestern Mem Hosp, Feinberg Sch Med, Chicago, IL 60611 USA

来源：

JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY | 2017年 / 28卷 / 11期

基金：

美国国家卫生研究院; 美国医疗保健研究与质量局;

关键词：

implantable cardioverter defibrillator; meta-analysis; primary prevention; IMPLANTABLE CARDIOVERTER-DEFIBRILLATOR; CARDIAC-RESYNCHRONIZATION THERAPY; VENTRICULAR-ARRHYTHMIAS TOVA; CORONARY-ARTERY-DISEASE; NONISCHEMIC CARDIOMYOPATHY; PRIMARY PREVENTION; ISCHEMIC CARDIOMYOPATHY; FOLLOW-UP; DILATED CARDIOMYOPATHY; MYOCARDIAL-INFARCTION;

D O I：

10.1111/jce.13307

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Background: No precise tools exist to predict appropriate shocks in patients with a primary prevention ICD. We sought to identify characteristics predictive of appropriate shocks in patients with a primary prevention implantable cardioverter defibrillator (ICD). Methods: Using patient-level data from the Multicenter Automatic Defibrillator Implantation Trial II (MADIT II) and the Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT), we identified patients with any appropriate shock. Clinical and demographic variables were included in a logistic regression model to predict appropriate shocks. Results: There were 1,463 patients randomized to an ICD, and 285 (19%) had >= 1 appropriate shock over a median follow-up of 2.59 years. Compared with patients without appropriate ICD shocks, patients who received any appropriate shock tended to have more severe heart failure. In a multiple logistic regression model, predictors of appropriate shocks included NYHA class (NYHA II vs. I: OR 1.65, 95% CI 1.07-2.55; NYHA III vs. I: OR 1.74, 95% CI 1.10-2.76), lower LVEF (per 1% change) (OR 1.04, 95% CI 1.02-1.06), absence of beta-blocker therapy (OR 1.61, 95% CI 1.23-2.12), and single chamber ICD (OR 1.67, 95% CI 1.13-2.45). Conclusion: In this meta-analysis of patient level data from MADIT-II and SCD-HeFT, higher NYHA class, lower LVEF, no beta-blocker therapy, and single chamber ICD (vs. dual chamber) were significant predictors of appropriate shocks.

引用

页码：1345 / 1351

页数：7

共 43 条

[11] A prospective randomized trial of single- or dual-chamber implantable cardioverter-defibrillators to minimize inappropriate shock risk in primary sudden cardiac death prevention [J].