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Transcatheter Aortic Valve Replacement

Abstract

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Original Research

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可穿戴复律除颤仪 & 心源性猝死

CBSMD

Pre-reading

心肌梗死后射血分数降低的患者有较高的猝死风险。复律除颤仪在心肌梗死后几个月到几年的期间可降低这些患者的死亡率。目前有关一级预防猝死相关指南的建议是将埋藏式心脏复律除颤器（implantable cardioverter-defibrillator ，ICD）的植入时间安排在急性心肌梗死后40天和血管再通畅后90天。而可穿戴复律除颤仪（Wearable Cardioverter- Defibrillator， WCD）在ICD植入前的这段等待期内可发挥预防猝死的作用。目前的指南对WCD给出了IIa级建议，适用于需要摘除ICD时的二级预防，对所有其他情况给出了IIb级建议，包括对高危人群的一级预防。


荟萃分析了28项研究“Wearable Cardioverter - Defibrillator Therapy for the Prevention of Sudden Cardiac Death A Systematic Review and Meta-Analysis”（32426名患者， 27项观察性研究，1项RCT研究）后得出：

1. 每100名患者中有5名接受3个月以上的WCD治疗；

2. RCT研究中缺血性心肌病患者接受3个月以上WCD治疗的比例较观察性研究低（每100人的比例为1:11）；

3. 每100名患者中有2名患者接受了治疗属治疗不当；

4. WCD治疗患者群的死亡率罕见，每100人中有0.7人。


迄今仅有的一项有关ICD的RCT研究——VAST研究在射血分数≤ 35%的、近期历经MI史的患者中随机比较可穿戴复律除颤仪对比非干预组(入组比例2:1)90天内死亡相对风险后得出：

1. 心律不齐死亡相对风险两组间无差异(relative risk, 0.67; 95% confidence interval [CI], 0.37 to 1.21; P=0.18)；

2. 可穿戴复律除颤仪对全因死亡事件起保护作用(relative risk, 0.63; 95% CI, 0.33 to 1.19; uncorrected P=0.15)。





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