预测埋藏式除颤器植入后的早期死亡率:选择患者的最佳临床风险评分  

Predicting early mortality after implantable defibrillator implantation: A clinical risk score for optimal patient selection

作　　者：Parkash R. Stevenson W.G. Epstein L.M. Maisel W.H. 宁宁 

机构地区：[1]Queen Elizabeth II Health Sciences Centre, Halifax Infirmary Site, 1796 Summer Street, Halifax, NS B3H 3A7, Canada Dr.

出　　处：《世界核心医学期刊文摘（心脏病学分册）》2006年第6期15-15,共1页

摘　　要：Background: Patients with advanced heart disease are at risk from sudden death; however, benefit from implantable cardioverter defibrillators(ICDs) may be limited as a result of early mortality from other causes. The objective of this study was to develop a model to predict mortality within the first year after ICD implantation. Methods and Results: A retrospective analysis was performed of 469 consecutive patients who underwent ICD implantation at a single tertiary- care center from 1999 to 2002. Vital status was determined from the Social Security Death Index. Patients were randomized into prediction and validation cohorts. A risk score was derived from the prediction cohort by multivariate logistic regression and applied to the validation cohort. One point was assigned for each variable in the risk score(age>80 years, history of atrial fibrillation, creatinine> 1.8 mg/dL,New York Heart Association class III or IV). One- year mortality significantly increased with increasing risk score in both the prediction and validation cohorts. Validation cohort mortality was 3.4% for 0 points, 4.3% for 1 point, 17% for 2 points, and 33% for ≥ 3 points(P for trend< .0001). A risk score ≥ 2 predicted a 1- year mortality rate of 21% , whereas a risk score< 2 predicted a mortality rate of 4% at 1 year(P< .0001). Conclusion: A risk score using simple clinical criteria may identify patients at high risk of early mortality after ICD implantation. This may be helpful in consideration of ICD risk/benefit for individual patients. Further studies conducted in a prospective manner using these clinical criteria are warranted.Background： Patients with advanced heart disease are at risk from sudden death; however, benefit from implantable cardioverter defibrillators（ICDs） may be limited as a result of early mortality from other causes. The objective of this study was to develop a model to predict mortality within the first year after ICD implantation. Methods and Results： A was performed of 469 consecutive patients who underwent ICD implantation at a single tertiary-care center from 1999 to 2002. Vital status was determined from the Social Security Death Index. Patients were randomized into prediction and validation cohorts. A risk score was derived from the prediction cohort by multivariate logistic regression and applied to the validation cohort. One point was assigned for each variable in the risk score（age〉 80 years, history of atrial fibrillation,

关 键 词：心脏病患者 埋藏式除颤器 早期死亡率 植入后 评分 风险 预测 logistic回归法 临床 三级医疗中心 

分 类 号：R151.4[医药卫生—营养与食品卫生学] R318.11[医药卫生—公共卫生与预防医学]