皮下与经静脉植入式除颤器治疗:随机试验和倾向评分匹配研究的系统回顾和荟萃分析。

Khi Yung Fong, Colin Jun Rong Ng, Yue Wang, Colin Yeo, Vern Hsen Tan
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引用次数: 0

摘要

皮下植入式心律转复除颤器(S-ICDs)作为经静脉植入式心律转复除颤器(TV-ICDs)的替代方案已经引起了人们的极大兴趣。目前尚未发表综合高质量研究数据的荟萃分析。方法和结果通过电子文献检索检索随机对照试验或倾向评分匹配研究,比较S-ICD和TV-ICD在植入式心律转复除颤器适应症患者中的应用。主要结局是器械相关并发症和导联相关并发症。次要结局为不适当休克、适当休克、全因死亡率和感染。所有结果在随机效应荟萃分析中汇总,并以风险比(rr)和95% ci报告。将器械相关并发症的Kaplan-Meier曲线数字化以检索个体患者数据,并使用Cox模型进行一期荟萃分析,以确定S-ICD患者与TV-ICD患者的风险比(hr)。共检索了5项研究(2387例患者)。与TV-ICD相比,S-ICD的器械相关并发症发生率相似(RR, 0.59 [95% CI, 0.33-1.04];P=0.070),但与导联相关的并发症发生率显著降低(RR, 0.14 [95% CI, 0.07-0.29];PP=0.167),但合并Kaplan-Meier曲线的目视检查显示偏向S-ICD的散度。两种治疗方式的次要结果无显著差异。结论S-ICD在铅相关并发症方面优于TV-ICD,且具有相当的疗效和安全性。从长远来看,S-ICD可能比TV-ICD更有利。这表明S-ICD可能是需要植入式心律转复除颤器植入而无起搏指征的患者电视- icd的合适替代品。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Subcutaneous Versus Transvenous Implantable Defibrillator Therapy: A Systematic Review and Meta-Analysis of Randomized Trials and Propensity Score-Matched Studies.

Subcutaneous Versus Transvenous Implantable Defibrillator Therapy: A Systematic Review and Meta-Analysis of Randomized Trials and Propensity Score-Matched Studies.

Subcutaneous Versus Transvenous Implantable Defibrillator Therapy: A Systematic Review and Meta-Analysis of Randomized Trials and Propensity Score-Matched Studies.

Subcutaneous Versus Transvenous Implantable Defibrillator Therapy: A Systematic Review and Meta-Analysis of Randomized Trials and Propensity Score-Matched Studies.

Background Subcutaneous implantable cardioverter-defibrillators (S-ICDs) have been of great interest as an alternative to transvenous implantable cardioverter-defibrillators (TV-ICDs). No meta-analyses synthesizing data from high-quality studies have yet been published. Methods and Results An electronic literature search was conducted to retrieve randomized controlled trials or propensity score-matched studies comparing S-ICD against TV-ICD in patients with an implantable cardioverter-defibrillator indication. The primary outcomes were device-related complications and lead-related complications. Secondary outcomes were inappropriate shocks, appropriate shock, all-cause mortality, and infection. All outcomes were pooled under random-effects meta-analyses and reported as risk ratios (RRs) and 95% CIs. Kaplan-Meier curves of device-related complications were digitized to retrieve individual patient data and pooled under a 1-stage meta-analysis using Cox models to determine hazard ratios (HRs) of patients undergoing S-ICD versus TV-ICD. A total of 5 studies (2387 patients) were retrieved. S-ICD had a similar rate of device-related complications compared with TV-ICD (RR, 0.59 [95% CI, 0.33-1.04]; P=0.070), but a significantly lower lead-related complication rate (RR, 0.14 [95% CI, 0.07-0.29]; P<0.0001). The individual patient data-based 1-stage stratified Cox model for device-related complications across 4 studies yielded no significant difference (shared-frailty HR, 0.82 [95% CI, 0.61-1.09]; P=0.167), but visual inspection of pooled Kaplan-Meier curves suggested a divergence favoring S-ICD. Secondary outcomes did not differ significantly between both modalities. Conclusions S-ICD is clinically superior to TV-ICD in terms of lead-related complications while demonstrating comparable efficacy and safety. For device-related complications, S-ICD may be beneficial over TV-ICD in the long term. These indicate that S-ICD is likely a suitable substitute for TV-ICD in patients requiring implantable cardioverter-defibrillator implantation without a pacing indication.

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