心衰患者起搏器升级CRT后的临床预后

Clinical prognosis of patients after upgrading from pacemakers to cardiac resynchronization therapy

目的探讨由单腔或双腔起搏器升级为三腔起搏器后患者的预后。方法本研究纳入2010年至2015年武汉亚洲心脏病医院植入CRT(cardiac resynchronization therapy)起搏器的患者。初次植入CRT组共108例,升级为CRT组共106例。其中升级为CRT-D组43例,升级为CRT-P组63例。随访三年。一级终点事件为全因死亡率。二级终点事件为因心衰加重而导致的住院,MACE事件(急性心肌梗塞、急性冠脉综合征、室速或室颤、房颤)。结果和初次植入CRT组比较,升级组全因死亡率更高(HR:1.835,95%CI:1.053-3.198,p=0.032),心衰住院率更高(HR:1.637,95%CI:1.131-2.370,p=0.009),MACE事件没有统计学差异(p=0.923)。升级为CRT-D组和升级为CRT-P组比较,全因死亡率更低(HR:0.361,95%CI:0.162-0.801,p=0.012),心衰住院率更低(HR:0.462,95%CI:0.271-0.790,p=0.005),MACE事件更低(HR:0.480,95%CI:0.261-0.886,p=0.019)。结论和初次植入CRT组比较,升级组全因死亡率更高,因心衰导致的住院率也更高,但MACE事件没有统计学差异。升级为CRT-D组和升级为CRT-P组比较,全因死亡率、心衰住院率和MACE事件更低。

Objective To explore the prognosis of patients after upgrading from pacemakers to cardiac resynchronization therapy. Methods This study included patients with CRT pacemakers implanted in Wuhan Asian heart hospital from 2010 to 2015. A total of 108 patients were initially implanted with CRT, and 106 were implanted with CRT upgraded. Among them, 43 cases were upgraded to CRT-D, and 63 cases were upgraded to CRT-P. The patients were followed up for three years. The first end event was all-cause mortality. Secondary endpoint events were hospitalization due to worsening heart failure, MACE events(acute myocardial infarction, acute coronary syndrome,ventricular tachycardia or ventricular fibrillation, atrial fibrillation). Results Compared with primary CRT group,all-cause mortality was higher in upgraded CRT group(HR: 1.835, 95% CI: 1.053-3.198, p=0.032), hospitalization rate due to heart failure was higher(HR: 1.637, 95% CI: 1.131-2.370, p=0.009), and MACE events were not statistically different(p=0.923). All-cause mortality was lower in the upgraded CRT-D group than in the upgraded CRT-P group(HR: 0.361, 95% CI: 0.162-0.801, p=0.012), hospitalization rate was lower in the upgraded CRT-D group(HR: 0.462, 95% CI: 0.271-0.790, p=0.005), and MACE events were lower in the upgraded CRT-D group(HR: 0.480, 95% CI: 0.261-0.886, p=0.019). Conclusions All-cause mortality and hospitalization due to heart failure were higher in the upgraded group than in the primary CRT group, but there was no significant difference in MACE events. All-cause mortality, hospitalization due to heart failure and MACE events were lower in the upgraded CRT-D group than in the upgraded CRT-P group.