心源性猝死SCD.ppt

Presentation Overview ? Sudden Cardiac Death Epidemiology, etiology, pathophysiology ? Overview of ICD therapy to prevent SCD ? Roles of Drugs in SCD Prevention ? Summary and conclusions Sudden death was the first manifestation of coronary heart disease in 50% of men and 63% of women. CHD accounts for at least 80% of sudden cardiac deaths in Western cultures. Application of ICD in China “Even the wealthiest nations cannot afford to pay to use  every medical advance in any patient who might benefit.” SCD Prevention by Antiarrhythmic Drugs CAST II: Cardiac Arrhythmia Suppression Trial II As with the antiarrhythmic agents used in CAST-I, the use of moricizine in CAST-II to suppress asymptomatic or mildly symptomatic ventricular premature depolarizations to try to reduce mortality after myocardial infarction is not only ineffective but also harmful. Average incidence of SCD in long term trials comparing blockers with placebo after MI  CAPRICORN: Carvedilol Post-Infarct Survival Control in LV Dysfunction  - TRIAL RESULTS - CIBIS II: Cardiac Insufficiency Bisoprolol Study II  - RESULTS - MERIT-HF: Metoprolol CR/XL Randomized Intervention Trial in  congestive Heart Failure - RESULTS - COPERNICUS: Carvedilol Prospective Randomized Cumulative Survival trial- SUMMARY - In patients with severe chronic heart failure, carvedilol in addition to standard therapy reduced: All-cause mortality Combined endpoint of all-cause mortality and hospitalization for any reason Meta-analysis of effects of amiodarone on SCD-RESULTS- Meta-analysis of the ICD secondary prevention trials Meta-analysis of effects of amiodarone on SCD - RESULTS - Meta-analysis of effects of amiodarone on SCD - RESULTS - ICD + AAD