起搏器培训课件：心脏再同步治疗新进展.pptVIP

* Patients censored at their 24-month follow-up. Some were before 24 months (730 days), hence the low number at risk. Some were after 24 months, hence the curves rising past 24 months. * In patients with mild symptoms and an indication for an implantable cardioverter defibrillator (ICD) for the primary prevention of sudden cardiac death, and a wide QRS, MADIT CRT was designed to determine whether cardiac resynchronisation therapy in combination with an ICD (CRT-D) and optimal medical therapy reduced all cause mortality and major heart failure events when compared with an ICD with optimal medical therapy. A nonfatal heart failure event included heart failure hospitalizations and outpatient administration of intravenous decongestive therapy. End point adjudication was made by independent, blinded committees. Key exclusion criteria included having an implanted pacemaker, a previous coronary artery bypass or percutaneous coronary intervention or myocardial infarction with 3 months, and atrial fibrillation within 1 month. Enrollment commenced in December 2004 and was completed in April 2008. Results were presented at the European Society of Cardiology meeting in September 2009, simultaneously with online publication in the New England Journal of Medicine. * At 12 months, significant reductions in left ventricular volumes and an increase in left ventricular ejection fraction were observed with CRT-D. An echocardiographic core laboratory was used to make the measurements. * * * * Possible customer’s question Why should I trust the REVERSE results when they are from a subgroup which was not randomised, and not from the overall population? First, the results are highly consistent with the overall results from REVERSE but were statistically significant in the 24-months population. So there are no contradictions in the data. Secondly, the results are very consistent across subgroups and for the different end points, indicating that there is a biological reason for the r