科研之友
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摘要
Implantable cardioverter-defibrillator (ICD) therapy decreases arrhythmic and all-cause mortality in patients at high risk of sudden death. However, its clinical benefit in elderly patients is uncertain. The aim of this study was to assess the long-term efficacy of ICD treatment in elderly patients and to identify markers of successful ICD therapy and risk factors of mortality. We performed multivariate analysis of a prospective long-term database from 2 tertiary care centers including 936 consecutive patients with an ICD. Predictors of ICD therapy and risk factors for mortality were assessed in patients %26gt;= 75 years old at ICD implantation compared to younger patients. Mean follow-up time was 43 +/- 40 months. Rates of ICD therapy were similar in the 2 age groups. No significant predictors of ICD therapy could be identified in older patients. Median estimated survival was 132 months in patients %26lt;75 years and 81 months in those %26gt;= 75 years old (p = 0.006). Decreased ejection fraction (hazard ratio 1.62 per 10% decrease, p = 0.03) and impaired renal hazard ratio 1.57 per 10 ml/kg/m(2) decrease in estimated glomerular filtration rate, p = 0.02) were independent risk factors of mortality in patients %26gt;= 75 years old. However, mortality of older patients was similar to that of the age-matched general population irrespective of delivery of ICD therapy. In conclusion, ICD therapy is effective for treatment of life-threatening arrhythmias in all age groups. However, prevention of sudden cardiac death may have limited impact on overall mortality in older patients. Despite a similar rate of appropriate ICD therapies, risk of death is increased 1.6-fold in ICD recipients %26gt;= 75 years old compared to younger patients. Patients with decreased ejection fraction and impaired renal function are at highest risk.
- 出版日期2012-3-1
