2012ACC精粹-0409推荐.ppt

研究背景 ISSUE 3 SYNCOPE 研究背景: 先前的两项研究表明，心脏起搏治疗因严重的反射性低血压或体位性低血压而不利于神经调节性晕厥的患者 #NMS：神经介导性晕厥 * VPS II trial. JAMA 2003; 289: 2224-2229 Synpace trial. Eur Heart J 2004: 25: 1741–1748 * 研究概况 ISSUE 3 SYNCOPE 随机、双盲、安慰剂对照试验 入选77例 40岁以上，有神经调节性晕厥 和已被证明有过心脏停搏的患者 主要终点：至第一次晕厥复发的时间 #NMS：神经介导性晕厥 * VPS II trial. JAMA 2003; 289: 2224-2229 Synpace trial. Eur Heart J 2004: 25: 1741–1748 * ISSUE 3 SYNCOPE 研究设计 神经介导性晕厥 ILR 植入 ILR 随访 (最长2年时间) 迷你植入心电记录器（ILR）筛查阶段 ISSUE 3 研究阶段 ILR 入选标准: 至少出现3s以上的心脏停搏所导致晕厥 或虽然未出现晕厥但心脏停搏至少6 s。 随机分组 起搏器 “开放”组 起搏器 “关闭”组 * log rank: p=0.039 RRR at 2 yrs: 57% 起搏器开放组 起搏器关闭组 至第一次晕厥复发时间 (意向性治疗分析) ISSUE 3 SYNCOPE 25% 37% 25% 57% * 研究结论 双腔永久起搏器可明显减少40岁及以上患者心脏停搏的神经性晕厥发作 起搏器置入后，患者晕厥绝对绝对减少率为32%，相对减少率57%，支持起搏器治疗用于良性神经调节性晕厥患者 采用可置入的环状记录器来确定起搏器的信号设备，有助于发现患者的阳性变化 * * ACEI: ACE inhibitors * * * * * * * us * * N-terminal fragment (NT-proBNP) * We have undertaken qol neuro and we are now cleaning/finalizing the data * Spell out AKIN and RIFLE Remove dialysis * * The efficacy of pacemaker therapy for prevention of syncopal recurrences in patients affected by neurally-mediated syncope (NMS) was questioned after two randomized double-blind controlled trials ….. * The efficacy of pacemaker therapy for prevention of syncopal recurrences in patients affected by neurally-mediated syncope (NMS) was questioned after two randomized double-blind controlled trials ….. * The pts who had an asystole 3 s…….were eligible for the ISSUE 3 study phase and were randomomized…. PM was effective, compared with Placebo, in an intention-to-treat analysis, to reduce the rate of recurrence of syncope during the follow-up * * Final Results from the ACCF-STS Database Collaboration on the Comparative Effectiveness of Revascularization Strategies (ASCERT) William S Weintraub, Maria V Grau-Sepulveda, Jocelyn M Weiss, Sean M. O’Brien, Eric D Peterson, Paul Kolm, Zugui Zhang, Lloyd W Klein, Richard E Shaw, Charles McKay, Laura L Ritzenthaler,