【正文】 % Mortality Reduction w/ ICD Rx % Mortality Reduction w/ ICD Rx 3 Years 3 Years 3 Years 1 Moss AJ. N Engl J Med. 1996。 80: 299301. 藥物治療更充分 CABG (Chronic CAD, mild angina, 3 VD) Hypertension therapy (Diastolic 95104 mmHg) Cardiac Transplant (CHF, transplant candidate) PTCA (Chronic CAD, mild angina, 1 VD) Primary coronary stenting (CAD, Angina, 1 VD, Male, age 55) CostEffectiveness of ICD Therapy and Other Cardiovascular Interventions Expensive Borderline Costeffective CostEffective Highly CostEffective Incremental Cost per LifeYear Saved Economically Unattractive ICD AVID Lovastatin (chol. = 290 mg/dL, 50 yrs old, male, no risk factors) ICD MADIT ICD MADIT II* estimate *Moss AJ. Presentation at Satellite Symposium, ―CostEffectiveness of Device Therapy in the Heart Failure Population‖, Heart Failure Society of America Annual Meeting September 23, 2022. $17,701 $28,751 $31,244 $40,753 $43,087 $50,000 $66,677 $88,944 $135,000 $0 $20,000 $40,000 $60,000 $80,000 $100,000 $120,000 $140,000 Number Needed to Treat To Save A Life (5 Yr) ( Yr) (3 Yr) (3 Yr) ( Yr) (1 Yr) (6 Yr) (2 Yr) NNTx years = 100 / (% Mortality in Control Group – % Mortality in Treatment Group) ICD Therapy Drug Therapy 3 4 11 9 20 26 28 37 0 5 10 15 20 25 30 35 40 45 50 MUSTT MADIT MADIT II AVID SAVE MeritHF 4S Amiodarone Meta analysis simvastatin captopril Metoprolol succinate amiodarone MADIT I, MUSTT AVID, CASH SCDHeFT, MADIT II Myerburg RJ, et al. Circulation. 1998. 97:15141521 SCD一級預(yù)防的危險人群分層 心力衰竭和冠心病是 SCD高危的主要人群 ? 50％男性和 63％女性冠心病病人首發(fā)癥狀為 SCD ? 50% SCD前無明顯冠心病，尸檢 90%SCD存在冠心病證據(jù) 5075%的 SCD確認為心梗后 ? 心肌梗死病史為獨立危險預(yù)測因子增加一年 SCD發(fā)生率 5% ? 心梗后伴 EF降低（ LVEF40%）， SCD危險比正常人高 46倍， 2年內(nèi)死亡率約 2030% ? 具有以下危險因子， 5年 SCD發(fā)生率將提高 32% ? 心肌梗死病史 ? 非持續(xù)性，可誘發(fā)，不可抑制性室速 ? LVEF≤40% SCD與冠心病、心肌梗死的關(guān)系 American Heart Association. Heart Disease and Stroke Statistics2022 Update. Dallas, Tex.: AHA。24:12041209 LVEF % 心臟性猝死發(fā)生率 % % % % 射血分數(shù)是 SCD危險分層的一個重要參數(shù) 0 1 2 3 4 5 6 7 8 030% 3140% 4150% 50% Bardy G. Arrhythmia Treatment and Therapy, Copyright 2022 by Marcel Dekker, Inc. , pp. 323342. Sweeney, MO. PACE 2022。351(24):24818 兩組病人的基本特征 Hohnloser SH, et al. N Engl J Med. 2022。361:14271436 LVEF≤ 40% on day 5–31 after AMI， HR ≥ 90 bpm on the first available ECG， NSVT ≥ 150 bpm during Holter Follow up ≥ 2 years Primary endpoint: all cause mortality Secondary endpoints:sudden cardiac death nonsudden cardiac death noncardiac death AIM: Highrisk patients after AMI will show a better survival when treated early with an ICD pared to patients receiving OMT alone All Cause Mortality 117 deaths 116 deaths Gerhard Steinbeck, et al. N Engl J Med. 2022。56:194203 ?第一個可以穿在體外而非置入體內(nèi)的心臟復(fù)律除顫器 ?適用于： SCD高危病人，不適合或不愿意安裝 ICD病人監(jiān) 測并治療其異常心律 ?由一個纏繞胸部的貼身電極帶，連接一個有警報裝置的腰部監(jiān)