课件：临床医学心衰器械治疗选择-还是-.ppt

* 2004年 COMPANION研究：CRT-D 治疗在不同年龄、不同性别、不同基础心脏病因、不同心功能分级、不同左心室射血分数、不同左心室舒张末径的心力衰竭患者获益的情况, 结论是处于不同情况的心力衰竭患者均能从CRT-D治疗中获益 。 The % of deaths classified as SCD. * 20 MUSTT was the next major primary prevention study that showed excellent results with ICD therapy. MUSTT was originally intended to compare EP-guided therapy (ICD or AAD) versus no antiarrhythmic therapy. On further analysis, the investigators found that ICD therapy was far superior to AAD drug therapy. The primary endpoint of MUSTT was arrhythmic mortality unlike all the other ICD trials which used overall mortality as the primary endpoint. The secondary endpoint in MUSTT was overall mortality. The entry criteria for MUSTT was similar to MADIT I: LVEF ? 40%, CAD, non-sustained VT, sustained VT on programmed electrical stimulation. Given the similar inclusion criteria, it is not surprising that the results of MUSTT were consistent with MADIT. After adjusting for covariates, MUSTT showed a 73% reduction in arrhythmic mortality and a 55% reduction in overall mortality in the ICD arm compared to patients taking no antiarrhythmic therapy. After the publishing of the MUSTT results, physician adoption of the MADIT indication increased significantly. This is not surprising given the consistent results and similar inclusion criteria of MADIT and MUSTT. By examining the Kaplan-Meier survival curves, we note that the ICD benefit began after approximately one year. Importantly, as demonstrated by the widening of the curves over time, the ICD benefit appears to increase over time. In an important recent analysis, Dr. Moss announced that there was a 40% cumulative probability of appropriate ICD therapy (ATP or shock) for VT or VF during the 4-year follow-up after ICD implantation. This finding clearly shows the improving cost-effectiveness of ICD therapy with longer follow-up periods.[i]  [i] Moss, Arthur. MADIT I and MADIT II. Journal of Cardiovascular Electrophysiology. Vol. 14, No. 9, September 2003 * * * *