Heart：ICD置入者临床转归存在性别差异
2013-06-04 高晓方 译 医学论坛网
荷兰一项研究表明，与男性相比，置入型心律转复除颤器（ICD）女性置入者的死亡率较低，并且适当ICD治疗倾向于较少。论文于5月30日在线发表于《心脏》（Heart）。 此项研究前瞻性人群研究共纳入1946例一级预防ICD置入患者，其中男、女性分别占79%和21%。主要转归指标为全因死亡、ICD治疗（抗心动过速起搏和电击）以及ICD电击。 结果显示，在中位随访3.3年期间，
荷兰一项研究表明，与男性相比，置入型心律转复除颤器（ICD）女性置入者的死亡率较低，并且适当ICD治疗倾向于较少。论文于5月30日在线发表于《心脏》（Heart）。
此项研究前瞻性人群研究共纳入1946例一级预防ICD置入患者，其中男、女性分别占79%和21%。主要转归指标为全因死亡、ICD治疗（抗心动过速起搏和电击）以及ICD电击。
结果显示，在中位随访3.3年期间，男、女性分别有387例（25%）和76例（18%）死亡。男、女性估计5年累积全因死亡率分别为20%和14%。对潜在混淆协变量进行校正之后，女性的全因死亡率较低（HR 0.65；P<0.01）。男、女性5年估计累积适当治疗发生率分别为24%和20%。校正之后非显著趋势依然存在。
Objective
To assess differences in clinical outcome of implantable cardioverter-defibrillator (ICD) treatment in men and women.
Design
Prospective cohort study.
Setting
University Medical Center.
Patients
1946 primary prevention ICD recipients (1528 (79%) men and 418 (21%) women). Patients with congenital heart disease were excluded for this analysis.
Main outcome measures
All-cause mortality, ICD therapy (antitachycardia pacing and shock) and ICD shock.
Results
During a median follow-up of 3.3 years (25th–75th percentile 1.4–5.4), 387 (25%) men and 76 (18%) women died. The estimated 5-year cumulative incidence for all-cause mortality was 20% (95% CI 18% to 23%) for men and 14% (95% CI 9% to 19%) for women (log rank p<0.01). After adjustment for potential confounding covariates all-cause mortality was lower in women (HR 0.65; 95% CI 0.49 to 0.84; p<0.01). The 5-year cumulative incidence for appropriate therapy in men was 24% (95% CI 21% to 28%) as compared with 20% (95% CI 14% to 26%) in women (log rank p=0.07). After adjustment, a non-significant trend remained (HR 0.82; 95% CI 0.64 to 1.06; p=0.13).
Conclusions
In clinical practice, 21% of primary prevention ICD recipients are women. Women have lower mortality and tend to experience less appropriate ICD therapy as compared with their male peers.
作者：高晓方 译
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