猝死的危险分层PPT课件.ppt

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1、TheEPshow:RiskstratificationforsuddendeathEricPrystowskyMDDirector,ClinicalElectrophysiologyLaboratoryStVincentHospitalIndianapolis,INArthurMossMDProfessorofMedicineandCardiologyUniversityofRochesterRochester,NYMichaelGoldMDChief,DivisionofCardiologyMedicalUniversitySo

2、uthCarolinaCharleston,SCRiskstratificationforsuddendeathHistoricallookatearlymarkersBeganduringthemid-1980swithaprospectivestudyofabout1000postinfarctionpatientsMeasured24-hourHolterrecordingsforventricularprematurebeatfrequencyDeterminedejectionfractionAscertainedseveral

3、otherroutineclinicalparametersMossHistoricallookatearlymarkersFoundinverserelationshipbetweentheejectionfractionandtotalmortalityaswellassuddendeathCutpointbetween30%and40%Recentstudies,includingMADITIandII,grewoutofthisearlyworkMossSerialelectrophysiologytestingMechani

4、sticallydrivenSuddendeathinpostinfarctionpatientspredominatelyduetoventriculartachycardiaIfyoucouldinduceventriculartachycardiaandintroduceadrugthatsuppressesthisability,youcouldmonitorefficacyGoldReviewingCASTCardiacArrhythmiaSuppressionTrial(CAST)Largerandomizedtrialtha

5、tlookedatwhethersuppressingventricularectopyafterMIreducessuddendeathTrialstoppedbecauseantiarrhythmicagentsassociatedwithincreasedmortalityReviewingCAST"Thissetthestageformovingfromantiarrhythmicagentstodevicetherapy."MossReviewingCASTCouldtheseresultsberelatedtothedrugs

6、selected?SubsequenttrialsconfirmedthatthiswasnotthecasePrystowskyMADITIWouldanICDorconventionaltherapyimprovesurvivalinthishigh-riskpopulation?Randomlyassigned196patientswithpriorMIand:NYHAfunctionalclass1,2,or3Aleftventricularejectionfraction<35%Anepisodeofasymptomaticun

7、sustainedventriculartachycardiaInducible,nonsuppressibleventriculartachyarrhythmiaonelectrophysiologicstudyMADITIfindingsGroupTotaldeathsCardiacdeathsDefibrillator1511Conventionaltherapy3927*Average27-monthfollow-upMADITIInhigh-riskpatientswithpriorMI,prophylactictherapyw

8、ithanICDleadstoimprovedsurvivalcomparedwithconventionalmedicaltherapyMUSTTMulticenterUnsustained