初次植入与升级心脏再同步化治疗后长期生存预后的对比分析

A comparative analysis of long-term survival outcomes after initial implantation and upgrated to cardiac resynchronization therapy

目的比较由心脏起搏器/埋藏式心脏转复除颤器升级为心脏再同步治疗(CRT)(升级组)与初次植入CRT(初次组)的患者的长期预后。方法入选自2005年9月至2015年6月接受CRT的患者,收集术前临床、心电图与心脏超声等基线资料以及全因死亡时间,对比升级组与初次组的长期生存。结果共入选389例患者,其中升级组29例,初次组360例,中位随访时间39.2个月,升级组与初次组分别有15例(51.7%)和139例(38.6%)患者死亡。log-rank检验显示升级组与初次组间生存终点无显著差异(HR 0.92,95%CI 0.54~1.59,P=0.77)。Cox多因素回归分析显示在校正基线资料后,升级与初次植入CRT的患者预后无差异(HR 0.79,95%CI 0.43~1.44,P=0.44)。结论升级CRT与初次植入CRT的患者长期生存预后无显著差异。

Objective To compare the long-term mortality of patients who received de novo cardiac resynchronization therapy(CRT)implantation(de novo group)and upgrade to CRT from cardiac pacemaker or implantable cardioverter defibrillator(upgrade group).Methods Patients who received CRT implantation from September 2005to June 2015were consecutively included.The baseline clinical,electrocardiographic and echocardiographic characteristics were collected,and survival analysis performed between de novo and upgrade groups.Results A total of 389 patients were enrolled,29in the upgrade group and 360in the de novo group.After a median follow-up time of 39.2months,15(51.7%)and 139(38.6%)patients died in the upgrade group and the de novo group,respectively.The log-rank test showed no significant difference in survival between the two groups(HR0.92,95%CI 0.54-1.59,P=0.77).Cox multivariate regression analysis showed that there was no significant difference in the prognosis of patients with CRT after adjustment for baseline confounders(HR0.79,95%CI 0.43-1.44,P=0.44).Conclusion There is no significant difference in long-term mortality between patients receiving upgrade and de novo CRT implantation.