本文由小咖机器人翻译整理

期刊来源：N Engl J Med

原文链接：https://doi.org/10.1056/NEJMoa2304542

摘要内容如下：

背景

非卧床心力衰竭再同步除颤试验（RAFT）显示，接受心脏再同步治疗（CRT）的患者比接受植入式心律转复除颤器（ICD）的患者在5年死亡率方面获益更大。然而，CRT对长期生存的影响尚不清楚。

方法

我们将纽约心脏协会（NYHA）II或III级心力衰竭、左心室射血分数为30%或更低、固有QRS持续时间为120毫秒或更长（或起搏QRS持续时间为200毫秒或更长）的患者随机分配接受单独的ICD或CRT除颤器（CRT-D）。我们评估了8个登记人数最多的参与地点的患者的长期结果。主要结局是任何原因导致的死亡；次要转归是任何原因导致的死亡、心脏移植或心室辅助装置植入的复合转归。

结果

该试验共纳入1798例患者，其中1050例纳入长期生存试验；1050名患者的中位随访时间为7.7年（四分位间距为3.9至12.8），存活者的中位随访时间为13.9年（四分位间距为12.8至15.7）。ICD组530例患者中有405例（76.4%）死亡，CRT-D组520例患者中有370例（71.2%）死亡。接受CRT-D的患者死亡时间似乎比接受ICD的患者更长（加速因子，0.80；95%置信区间，0.69至0.92；P=0.00 2）。ICD组和CRT-D组分别有412例（77.7%）和392例（75.4%）患者发生了次要结局事件。

结论

在射血分数降低、QRS波群增宽和NYHA II级或III级心力衰竭的患者中，与ICD相比，接受CRT-D的生存获益似乎在中位数近14年的随访期间持续存在。（RAFT ClinicalTrials.gov编号，NCT00251251。）

英文原文如下：

Abstracts

BACKGROUND  The Resynchronization-Defibrillation for Ambulatory Heart Failure Trial (RAFT) showed a greater benefit with respect to mortality at 5 years among patients who received cardiac-resynchronization therapy (CRT) than among those who received implantable cardioverter-defibrillators (ICDs). However, the effect of CRT on long-term survival is not known.

METHODS  We randomly assigned patients with New York Heart Association (NYHA) class II or III heart failure, a left ventricular ejection fraction of 30% or less, and an intrinsic QRS duration of 120 msec or more (or a paced QRS duration of 200 msec or more) to receive either an ICD alone or a CRT defibrillator (CRT-D). We assessed long-term outcomes among patients at the eight highest-enrolling participating sites. The primary outcome was death from any cause; the secondary outcome was a composite of death from any cause, heart transplantation, or implantation of a ventricular assist device.

RESULTS  The trial enrolled 1798 patients, of whom 1050 were included in the long-term survival trial; the median duration of follow-up for the 1050 patients was 7.7 years (interquartile range, 3.9 to 12.8), and the median duration of follow-up for those who survived was 13.9 years (interquartile range, 12.8 to 15.7). Death occurred in 405 of 530 patients (76.4%) assigned to the ICD group and in 370 of 520 patients (71.2%) assigned to the CRT-D group. The time until death appeared to be longer for those assigned to receive a CRT-D than for those assigned to receive an ICD (acceleration factor, 0.80; 95% confidence interval, 0.69 to 0.92; P = 0.002). A secondary-outcome event occurred in 412 patients (77.7%) in the ICD group and in 392 (75.4%) in the CRT-D group.

CONCLUSIONS  Among patients with a reduced ejection fraction, a widened QRS complex, and NYHA class II or III heart failure, the survival benefit associated with receipt of a CRT-D as compared with ICD appeared to be sustained during a median of nearly 14 years of follow-up. (RAFT ClinicalTrials.gov number, NCT00251251.).

-----------分割线---------

点击链接：https://www.mediecogroup.com/community/user/vip/categories/ ，成为医咖会员，获取12项专属权益。

现在购买可享受最大优惠（买一年送三个月，买两年送一年），2024年2月10日起将不再享有该优惠。