植入式心律转复除颤器与胺碘酮对癌症患者预后的比较

IF 2.2 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Arrhythmia Pub Date : 2025-05-19 DOI:10.1002/joa3.70093

Hirota Kida CE, MS, PhD, Toshitaka Morishima MD, PhD, Eiji Uza CE, MS, Hironori Yamamoto MD, PhD, Taku Yasui MD, PhD, Masashi Fujita MD, PhD, Isao Miyashiro MD, PhD

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引用次数: 0

摘要

与胺碘酮相比，植入式心律转复除颤器（ICD）已被证明可以改善生存结果。然而，这种方法在癌症患者中的有效性尚不清楚。考虑到该人群心血管管理的复杂性，包括癌症分期的考虑，我们评估了ICD与胺碘酮在癌症患者中的相对有效性。方法和结果我们将癌症登记数据与行政记录联系起来，以确定2010年至2015年间日本大阪府36家医院新开胺碘酮或植入ICD的患者。在161125例癌症患者中，339例符合纳入标准(胺碘酮：n = 281；ICD: n = 58)，中位随访762天。Kaplan-Meier分析显示，与胺碘酮组相比，ICD组的全因死亡风险显著降低（Log-rank检验，p < .003）。多变量Cox比例风险回归模型显示，ICD是独立的预后因素（风险比：0.47,95%可信区间：0.29-0.79,p = 0.004）。这些结果在倾向匹配分析中得到证实。在癌症分期：原位或局部的患者中，ICD组和胺碘酮组的生存风险无显著差异，ICD与全因死亡无显著相关。相反，在癌症分期为区域性或远处的患者中，与胺碘酮组相比，ICD组的全因死亡风险显著降低，ICD是一个独立的预后因素。结论与胺碘酮相比，ICD可改善癌症患者的长期预后，尤其是晚期癌症患者。

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Prognostic comparison between implantable cardioverter-defibrillator and amiodarone in cancer patients

Background

Implantable cardioverter-defibrillator (ICD) has been demonstrated to improve survival outcomes compared to amiodarone. However, this effectiveness in cancer patients remains unclear. Given the complexity of cardiovascular management in this population, including cancer stage considerations, we evaluated the relative effectiveness of ICD versus amiodarone in cancer patients.

Methods and Results

We linked cancer registry data with administrative records to identify patients newly prescribed amiodarone or who underwent ICD implantation between 2010 and 2015 at 36 hospitals in Osaka Prefecture, Japan. Among 161,125 cancer patients, 339 met the inclusion criteria (amiodarone: n = 281; ICD: n = 58), with a median follow-up of 762 days. Kaplan–Meier analysis revealed that the ICD group had a significantly reduced risk of all-cause mortality compared to the Amiodarone group (Log-rank test, p < .003). Multivariable Cox proportional hazard regression model showed that ICD was an independent prognostic factor (Hazard ratio: 0.47, 95% confidence interval: 0.29–0.79, p = .004). These results were confirmed in a propensity-matched analysis. Among patients with cancer stage: in situ or localized, no significant difference in survival risk was observed between the ICD and Amiodarone groups, and ICD was not significantly associated with all-cause death. Conversely, among patients with cancer stage: regional or distant, the ICD group had a significantly reduced risk of all-cause death compared to the Amiodarone group, and ICD was an independent prognostic factor.