icd在猝死一級預防中的應(yīng)用-在線瀏覽
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【正文】 s 31% 56% 28% 59% 20% 33% % Mortality Reduction w/ ICD Rx % Mortality Reduction w/ ICD Rx 3 Years 3 Years 3 Years 1 Moss AJ. N Engl J Med. 1996。341:188290， 3 Moss AJ. N Engl J Med. 2022。337: Kuck K. Circ. 2022。 337: 15761583.. Moss AJ. N Engl J Med. 2022。 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。 1997:chapter 24. Lombardi G. JAMA. 1994。 Bigger JT. Circulation. 1984。145:515521. % Mortality 31% 24% 44% 6% 34% 29% 49% 9% 0 10 20 30 40 50 60 VF VT VF and VT No VF or VT 30 day mortality 1 year mortality ICD對冠心病 SCD的一級預防結(jié)論 ? MADITI、 MADITII研究表明心梗后發(fā)生過 VT的高?；颊哳A防性植入 ICD 能明確改善患者生存率 ? MUSTT研究表明對冠心病，低 EF，無癥狀非持續(xù)性VT預防性植入 ICD能明確改善生存率 , 而 EP指導藥物治療無效 ? 與 AAD和其它治療相比 ICD預防能降低 MI后死亡率3155% ? 心梗后患者一級預防效力超過二級預防 SCD與心功能不全的關(guān)系 MERITHF Study Group. 。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。21:51725. Prior SG, e
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