SCD-HeFT研究,PROVE-IT研究和SYNERGY研究PPT课件.ppt

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1、ACC2004:SCD-HeFT,PROVE-IT,andSYNERGYunderdebateEricJTopolMDProvostandChiefAcademicOfficerChairman,DepartmentofCardiovascularMedicineClevelandClinicFoundationCleveland,OHRobertMCaliffMDProfessorofMedicineAssociateViceChancellorforClinicalResearchDirector,DukeClinicalResearchInstituteDukeUnivers

2、ityMedicalCenterDurham,NCSCD-HEFTSuddenCardiacDeathinHeartFailureTrialPROVE-ITPravastatinorAtorvastatinEvaluationandInfectionTherapySYNERGYSuperiorYieldoftheNewStrategyofEnoxaparin,Revascularization,andGlycoproteinIIb/IIIaInhibitorsTopicsSuddenCardiacDeathinHeartFailureTrialSCD-HeFTBackgroundDrGust

3、Bardy(SeattleInstituteforCardiacResearch,WA)andcolleagues:Dodefibrillatorssavelives?Wouldtheybeusefulinthemoregeneralpopulationofpatientswithheartfailure?SCD-HeFTDesignSCD-HeFT2521patientswithNYHAclass2-3HFandLVEF<35%148centersinNorthAmericaandNewZealandLargestinternal-cardioverter-defibrillator(ICD

4、)trialeverconductedICDvsplaceboMedianfollow-upof45monthsPublicandprivatelysponsored:MedtronicInc(Minneapolis,MN)WyethPharmaceuticals(Madison,NJ)TheNationalHeart,Lung,andBloodInstitute(Bethesda,MD)FundingSCD-HeFTICDpatientsSCD-HeFTAll-causemortalityICDAmiodaronePlacebo3years(%)17.124.022.35years(%)28

5、.934.135.8All-causemortalitySCD-HeFTPopulationNumber(ICD+control)HR*97.5%CIAllpatients16760.77**0.62-0.96NYHAclass211600.540.40-0.74NYHAclass35161.160.84-1.61IschemicHF8840.790.60-1.04NonischemicHF7940.730.50-1.04*HR=hazardratio**p=0.007Relativeriskforall-causemortalitySCD-HeFTPopulationNumber(ICD+c

6、ontrol)HR97.5%CILVEF<30%13900.730.57-0.92LVEF>30%2851.080.57-2.07QRS<120ms9770.840.62-1.14QRS>120ms6990.670.49-0.93Onbetablockers11570.680.51-0.91Notonbetablockers5190.920.65-1.30Relativeriskforall-causemortalitySCD-HeFTStandardmedicaltherapyMedicationBaselinerate(%)Rateatlastfollow-up(%)ACEinhibito

7、rs8572ACEinhibitorsorangiotensinreceptorblockers9687Betablockers6978Statins3847SCD-HeFT"Oneofthemostimpressivetrialsinsuddencardiacdeathsanddefibrillators.""WhatIthoughtaboutthistrial,whichwassoextrao