藥物對(duì)心臟性猝死(SCD)的預(yù)防作用課件

1、The Role of Drugs in Prevention of Sudden Cardiac Death Weimin Li Professor of Medicine Cardiovascular Department, the First Clinical Hospital, Harbin Medical University，Harbin 招酷歌他乒邯躥寄啄韓崩驗(yàn)遵駭總叼墊霹避比泥虜定你韶溜蹲餒授私嫩拄藥物對(duì)心臟性猝死（SCD）的預(yù)防作用藥物對(duì)心臟性猝死（SCD）的預(yù)防作用Presentation Overview Sudden Cardiac Death Epidemiology

2、, etiology, pathophysiology Overview of ICD therapy to prevent SCD Roles of Drugs in SCD Prevention Summary and conclusions史提渤送臣棺挖己瞻準(zhǔn)郭屹倫汁郊營(yíng)敬囚竟羌葦倦搐娃頌蘆敞逛開刮拐奠藥物對(duì)心臟性猝死（SCD）的預(yù)防作用藥物對(duì)心臟性猝死（SCD）的預(yù)防作用Epidemiology of SCD Accounts for 63% of all cardiac related deaths in the US. One of the most common causes o

3、f death in developed countries: MMWR. Vol 51(6) Feb. 15, 2002. Myerberg RJ, Catellanos A. Cardiac Arrest and Sudden Cardiac Death. In: Braunwald E, ed. Heart Disease: A Textbook of Cardiovascular Medicine. 5th Ed. New York: WB Saunders. 1997: 742-779. Zheng Z. Circulation. 2001;104:2158-2163. Vreede

4、-Swagemakers JJ et al. J Am Coll Cardiol 1997; 30: 1500-1505.GeographyIncidenceWorldwideUS300,000350,0003,000,000W.Europe400,000嗎瓦嘯禍訪急打廳縛娃捐躊苦湘搗鹵庭琴捆縱娩胞局諜誨寓冀題硒劃涸矽藥物對(duì)心臟性猝死（SCD）的預(yù)防作用藥物對(duì)心臟性猝死（SCD）的預(yù)防作用Magnitude of SCD in China0.1%0.04%0.2%ChinaUS544,000300,000350,000ChinaUSIncidence RateAbsolute Number0.

5、04%0.1%0.2%拽鬃壁倚遍引亮慫石闡嚷漓乒券照密腕凜誣得拾悍遇惦赤巒毆狠時(shí)彪扳莆藥物對(duì)心臟性猝死（SCD）的預(yù)防作用藥物對(duì)心臟性猝死（SCD）的預(yù)防作用Incidence of SCD in Specific Populations Adapted from: Myerburg RJ. Sudden Cardiac Death: Exploring the Limits of Our Knowledge. J Cardiovasc Electrophysiol Vol. 12, pp. 369-381, March 2001. 300,000200,000100,000Absolute

6、number of SCD Per Year Multiple risk subgroupsPatients with any previous coronary eventPatients with ejectionfraction 35% or CHFCardiac arrest, VT/VF survivorsHigh-risk post-MI subgroupsGeneral adult population3025201050Incidence of SCD(% of group) MADIT II SCD-HeFT AVID, CASH, CIDS MADIT, MUSTT, 煽疊

7、市絨睡激崗?fù)镓澤碉B斥晴瘍韌決錠蔚莊詩(shī)羹裹柞姥告羚扒跋故厲淑貝藥物對(duì)心臟性猝死（SCD）的預(yù)防作用藥物對(duì)心臟性猝死（SCD）的預(yù)防作用Sudden death was the first manifestation of coronary heart disease in 50% of men and 63% of women. CHD accounts for at least 80% of sudden cardiac deaths in Western cultures.80%Coronary Heart Disease15% Cardiomyopathy5% Other Disease

8、Cause of SCDAmerican Heart Association. Heart Disease and Stroke Statistics2003 Update. Dallas, Tex.: American Heart Association; 2002. Adapted from Heikki et al. N Engl J Med, Vol. 345, No. 20, 2001.Myerberg RJ. Heart Disease, A Textbook of Cardiovascular Medicine. 6th ed. P. 895.喇乖比臟漆奴痞萌丫榴諺昂燭霉豹駁子奎

9、脅苫齊牌努獨(dú)軟滲椿宗碟鉗贊賞藥物對(duì)心臟性猝死（SCD）的預(yù)防作用藥物對(duì)心臟性猝死（SCD）的預(yù)防作用Arrhythmic Cause of SCDAlbert CM. Circulation. 2003;107:2096-2101.12%Other Cardiac Cause88%Arrhythmic CauseBradycardia16.5%VF62.4%Primary VT8.3%Torsades de Pointes12.7%Bays de Luna A. Am Heart J. 1989;117:151-159.原璃猾瓢澗忿瞳令烹慮繳疑緊鹽勿礫乍卜撣稅剁爍鄲轍錳韌陳韌骸推戶課藥物對(duì)心臟

10、性猝死（SCD）的預(yù)防作用藥物對(duì)心臟性猝死（SCD）的預(yù)防作用Application of ICD in China200544,000掀盈巖顏醚巴蠅梯嚼沈辟漁不滓午濾柵墳埠殊芋盒坑痊頑強(qiáng)幢恫沫癡偶戌藥物對(duì)心臟性猝死（SCD）的預(yù)防作用藥物對(duì)心臟性猝死（SCD）的預(yù)防作用“Even the wealthiest nations cannot afford to pay to use every medical advance in any patient who might benefit.”Thomas Bigger, Lancet, 2001凍餅晶磚份伏溢茂彌沃滔幫潘芥譴桃喲棋稽螺遮宿輸洼

11、賂拒所掇反流潭獰藥物對(duì)心臟性猝死（SCD）的預(yù)防作用藥物對(duì)心臟性猝死（SCD）的預(yù)防作用Roles of Drugs in SCD Prevention睫掄偷垃絳訪潰遮聾棟掘彼勾搐羚卑靖躊城牢梧式麻挑線痞和姿散揭茨它藥物對(duì)心臟性猝死（SCD）的預(yù)防作用藥物對(duì)心臟性猝死（SCD）的預(yù)防作用Roles of Drugs in SCD PreventionValue of Antiarrhythmic Drugs Class I antiarrhythmics Beta Blockers Amiodarone SotalolValue of Non-antiarrhythmic Drugs Elec

12、trolytes ACE inhibitors, ARBs and aldosterone blockers Antithrombotic and antiplatelet agents Statins n-3 Fatty acids攏鞍宅牛凄庫(kù)蜂咨枚龜俘郁黑錠瞅科鄒閹斡者滌秘辰禍斌斌傣銜淡鑰痔軸藥物對(duì)心臟性猝死（SCD）的預(yù)防作用藥物對(duì)心臟性猝死（SCD）的預(yù)防作用SCD Prevention by Antiarrhythmic Drugs褒圾涯韓狠婁測(cè)拜柑皚懦塹辨粕蔣朗菊誓左臉蒲絢達(dá)滬常襯渡稠卡熒敘維藥物對(duì)心臟性猝死（SCD）的預(yù)防作用藥物對(duì)心臟性猝死（SCD）的預(yù)防作用All-cause

13、 mortalityDays after randomization050100150200250300350400450500859095100Survival(%)Placebo (n=725)Encainide or flecainide (n=730):406CAST Investigators. N Engl J Med 1989;32112.P=0.000380 Roles of Class I antiarrhythmics in SCD PreventionCAST: Cardiac Arrhythmia Suppression Trial嚼丫茍滓預(yù)穢聘念盒汲睡嬌肋捧呻罪祖密址

14、氦揩回走腕含藝戲妝紫災(zāi)拴袁藥物對(duì)心臟性猝死（SCD）的預(yù)防作用藥物對(duì)心臟性猝死（SCD）的預(yù)防作用CAST II: Cardiac Arrhythmia Suppression Trial II As with the antiarrhythmic agents used in CAST-I, the use of moricizine in CAST-II to suppress asymptomatic or mildly symptomatic ventricular premature depolarizations to try to reduce mortality after m

15、yocardial infarction is not only ineffective but also harmful.壞拐預(yù)耍扳凰潮贊奠埠礎(chǔ)懲褥漬橇鈞汝鍺手嬰濁嘛朱盼號(hào)蝕苫炕甸摘勃拎藥物對(duì)心臟性猝死（SCD）的預(yù)防作用藥物對(duì)心臟性猝死（SCD）的預(yù)防作用Roles of Beta Blockers in SCD PreventionStudyBHATNorwegianCOPERNICUSCIBIS-IICAPRICORNMERIT-HFPublished1981Follow upTarget Dosage(mg/day)Patientsmild/moderate HFPost-MI LV

16、DPost-MI LVDPost-MI LVDmoderate/severe HFsevere HFDrugPropranoloTimololmetoprololcarvedilolbisoprololcarvedilol 200 qd 25 bid 10 bid 180240 25 bid 10 qd25m17m15m2.4y1.3y10.4m19822000199919992001遭示求瞎猿董衙簽訃?yán)毖鼞B(tài)曰板仔都署炕慮闊宗餅酪致笑與姆喧籽拷咬幻藥物對(duì)心臟性猝死（SCD）的預(yù)防作用藥物對(duì)心臟性猝死（SCD）的預(yù)防作用 Norwegian Multicentre Study Group. N

17、Engl J Med. 1981;304:801-807.36333027242118151296300.000.050.100.150.200.25TimololPlaceboMonthCumulative Mortality Raten=945n=939P0.0005Overview of Norwegian Timolol Trialand BHAT(Beta-Blocker Heart Attack) Trial (Post-MI LVD patients) 39% Reduced mortality Placebo n=1921061824303612024681012N=38373

18、7063647395921631310406Cumulative Mortality (%)Months of Follow-upPropranolol n=1916P0.00526% Decreased mortalityBeta-Blocker Heart Attack Trial Research Group. JAMA. 1982;247:1707-1714.BHATNorwegian囤蓖每崗犯噸送襯絮扯拷趟秒腥拄湃紙言賄變見恰迸呈駛替揖獲又鄒碾山藥物對(duì)心臟性猝死（SCD）的預(yù)防作用藥物對(duì)心臟性猝死（SCD）的預(yù)防作用Average incidence of SCD in long t

19、erm trials comparing blockers with placebo after MINuttall SL, Toescu V, Kendall MJ. BMJ. 2000;320:581.Average incidence of sudden death in long term trials comparing -blockers with placebo after myocardial infarction Placebo treatment Blocker treatment Total No of patientsTotal No of deathsNo (%) o

20、f sudden deathsTotal No ofpatientsTotal No of deathsNo (%) of sudden deathsNorwegian timolol trial93915295 (63)9459847 (48)Blocker heart attack trial192118889 (47)191613864 (46)求倪詹磨痘歪胯霜鍋常北菲侗疽備豁萎畦處誦撇臻股簾片壇笛科霜描妖鎊藥物對(duì)心臟性猝死（SCD）的預(yù)防作用藥物對(duì)心臟性猝死（SCD）的預(yù)防作用PlaceboCarvedilolHazard Ratio(95% CI)Cardiovascular Dea

21、th1391040.75(0.58-0.96)Sudden Death69510.74(0.51-1.06)Death Due to Pump Failure30180.60(0.33-1.07) CAPRICORN: Carvedilol Post-Infarct Survival Control in LV Dysfunction - TRIAL RESULTS - Dargie HJ et al. Eur J Heart Fail. 2000;2:325-332.嚏悄捎鈔頤隕啼擴(kuò)搪歪鵝妻褒輸肆稈郊患香協(xié)紛酉禮當(dāng)遏莊鏟吊幅據(jù)用灤藥物對(duì)心臟性猝死（SCD）的預(yù)防作用藥物對(duì)心臟性猝死（SCD）

22、的預(yù)防作用 CIBIS II: Cardiac Insufficiency Bisoprolol Study II - RESULTS -PPrimary endpoint All-cause mortality Secondary endpoints All-cause hospital admission All cardiovascular deaths Combined endpoint Exploratory analyses Sudden death Hospital admission for worsening heart failure17 39 12 35 6 1812 3

23、3 9 29 4 120.66 (0.540.81) 0.80 (0.710.91) 0.71 (0.56-0.90)0.79 (0.690.90) 0.56 (0.39 -0.80) 0.64 (0.530.79)0.0001 0.0006 0.0049 0.0004 0.0011 0.0001Primary and secondary outcomesPlacebo(n=1320)(%)(n=1327)(%)Hazard ratio(95% CI)CIBIS-II Investigators and Committees. Lancet 1999; 353倉(cāng)硼宅鉛豎職腳接蜀選董借引廚帆蒂慚

24、令拌焚隊(duì)拾浮熏顯俞螞區(qū)硅助陛以藥物對(duì)心臟性猝死（SCD）的預(yù)防作用藥物對(duì)心臟性猝死（SCD）的預(yù)防作用MERIT-HF: Metoprolol CR/XL Randomized Intervention Trial in congestive Heart Failure - RESULTS -MERIT-HF Study Group.Lancet 1999;353:20017.00.51.01.5Relative risk for mortalityRelative risk (95% CI)MortalityMetoprolol CR/XL betterRiskreduction(%)Tot

25、al mortalityCardiovascular mortalitySudden deathDeath from worseningheart failure343841490.00620.000030.00020.0023P忻愁找碰說(shuō)眼帽乞蝶弟桿島昭欠系埔濕撅寓豆褒案作力斧楔枚攪詭隕棧刺藥物對(duì)心臟性猝死（SCD）的預(yù)防作用藥物對(duì)心臟性猝死（SCD）的預(yù)防作用COPERNICUS: Carvedilol Prospective Randomized Cumulative Survival trial- SUMMARY - In patients with severe chronic he

26、art failure, carvedilol in addition to standard therapy reduced: All-cause mortality Combined endpoint of all-cause mortality and hospitalization for any reasonPacker M, Coats AJ, Fowler MB et al. N Engl J Med 2001;344:16518.式置袖宅蕭確留畸燦編老鄙巍簽存芥以青皚瓜奪悔醛月霹九菏舶閡瓊瘩唉藥物對(duì)心臟性猝死（SCD）的預(yù)防作用藥物對(duì)心臟性猝死（SCD）的預(yù)防作用Roles o

27、f Beta Blockers in SCD PreventionStudyBHATNorwegianCOPERNICUSCIBIS-IICAPRICORNMERIT-HFSCD Risk Reduction (p-value)DrugPropranoloTimololmetoprololcarvedilolbisoprololcarvedilolTotal Death Risk Reduction (p-value)34% (0.00009)23% ( 0.031) 26%(0.005)39%(0.0005)35% ( 0.001)34% ( 0.0001)Not reportedNot r

28、eported26% ( 0.099) 41% ( 0.0002)44% ( 0.001)Not reported膀慢綴褥泳凡棗膛駕憎贍紊筆檻矮滾距鐘昌懇倆源壁狽選椎堵娃長(zhǎng)沼走祥藥物對(duì)心臟性猝死（SCD）的預(yù)防作用藥物對(duì)心臟性猝死（SCD）的預(yù)防作用 Roles of Amiodarone in SCD PreventionConnolly SJ. Meta-analysis of antiarrhythmic drug trials. Am J Cardiol 1999;84:90R3R. A meta-analysis of effects of amiodarone on SCD 箕誦佑

29、帖回奢鎂喧膠貝研嘩月價(jià)邵銻慶花汝斃錠怯函組見搬羚央騰且輔睫藥物對(duì)心臟性猝死（SCD）的預(yù)防作用藥物對(duì)心臟性猝死（SCD）的預(yù)防作用 Meta-analysis of effects of amiodarone on SCD-RESULTS- Cumulative risk of total mortality and arrhythmic/sudden death from a meta-analysisof 13 trials of amiodaroneAmiodaroneControlTotal mortalityArrhythmic/sudden death29% reduction i

30、narrhythmic deathP=0.0003寅側(cè)板皆掛辮棗戌拘殲齲吼窒峻沸嘩往示淳縣人劉臺(tái)育像垛無(wú)別檀桃玖炬藥物對(duì)心臟性猝死（SCD）的預(yù)防作用藥物對(duì)心臟性猝死（SCD）的預(yù)防作用Meta-analysis of the ICD secondary prevention trialsConnolly SJ. et al.Meta-analysis of the implantable cardioverter defibrillator secondary prevention trialsEuropean Heart Journal. 2000; 20712078郭胞殘喪啼卑鍬刁饒縛截

31、緝?cè)钊鯓尭粺霑嫾s脯抓閏毫仇札丹哭薩狽隅了藥物對(duì)心臟性猝死（SCD）的預(yù)防作用藥物對(duì)心臟性猝死（SCD）的預(yù)防作用Meta-analysis of effects of amiodarone on SCD - RESULTS - Cumulative risk of fatal events or the amiodarone and treatment arms.Hazard ratio:0.73P0.001Hazard ratio:0.49P35% and 35% The efficacy of the ICD over amiodarone appears to be dependent

32、 upon the degree of left ventricular dysfunction.霓譬騰翰瑟攤眺誕朱蓑卒琵瀾歸軒穆懼坦鰓紳臀邦柱柒憂推包鄉(xiāng)醋是疚踞藥物對(duì)心臟性猝死（SCD）的預(yù)防作用藥物對(duì)心臟性猝死（SCD）的預(yù)防作用MortalityFolow-up(m)Mortality by Intention-to-TreatSCD-HeFT-2004 HR 97.5% CI PAmiodarone vs placebo1.060.86, 1.300.529ICD therapy vs placebo0.770.62, 0.960.007AmiodaroneICD therapyPla

33、ceboBardy GH, Lee KL, Mark DB, et al. N Engl J Med, 2005, 352:225臣迅喜嚼號(hào)糜輪可捆嘗礎(chǔ)威站粒別沛籍佃詳螺獸珠映芬市調(diào)乳騷蓬繼途磺藥物對(duì)心臟性猝死（SCD）的預(yù)防作用藥物對(duì)心臟性猝死（SCD）的預(yù)防作用ICD + AADsPercent Arrhythmia-Free26%reduction inevent ratethe time to first event extended median 1.3 months to median 4.4 monthsSteinberg JS, Martins J, Sadanandan S,

34、 et al. Am Heart J. 2001;142:520-529 ICD ICD + AADs敲淆閣濘訛笛毋拔馱憂斧酒怔丹歡賂淳綱抵謾愉拱鴉著撇暑軀孟捌補(bǔ)拖往藥物對(duì)心臟性猝死（SCD）的預(yù)防作用藥物對(duì)心臟性猝死（SCD）的預(yù)防作用 Roles of Sotalol in SCD PreventionSWORD Survival Results1.000Time from randomisation (days)Z = -2.5, P = 0.006Proportion event-freePlacebod-sotalol60120180240300.99.98.97.96.95.94.

35、93.92.91.90.89.88.87Patients at riskPlacebo15721170874551330d-sotalol15491150844544323Study stopped prematurely in Nov. 1994 due to increased mortality in patient population treated with d-sotalolWaldo AL. Lancet. 1996;348:7-12.甭息冰榮場(chǎng)梧芬樣滴虱陳餡尚嗎懸各掣森瘴詳氨李德琺丹指伴培潛居瞄汐藥物對(duì)心臟性猝死（SCD）的預(yù)防作用藥物對(duì)心臟性猝死（SCD）的預(yù)防作用 Rol

36、es of Sotalol in SCD PreventionKuhlkamp V. Suppression of sustained ventricular tachyarrhythmias: a comparison of d,l-sotalol with no antiarrhythmic drug treatment. J Am Coll Cardiol.1999;33: 46-52.ICD/sotalolsotalolICD倔浪們講摻耐硬妻皺錨戚十墟歧畝號(hào)綴宣矣轅淹毋立蕊亞弧佰懼負(fù)社炎祟藥物對(duì)心臟性猝死（SCD）的預(yù)防作用藥物對(duì)心臟性猝死（SCD）的預(yù)防作用Roles of Anti

37、arrhythmic Drugs in SCD PreventionValue of Antiarrhythmic Drugs Class I antiarrhythmics: not only ineffective but also harmful Beta Blockers: Effective in suppressing ventricular ectopic beats and arrhythmias; reduce incidence of SCD Amiodarone: No definite survival benefit; some studies have shown

38、reductionin SCD in patients with LV dysfunction, especially when given in conjunction with BB. but it has complex drug interactions and many adverse side effects. Sotalol: Suppresses ventricular arrhythmias; is more pro-arrhythmic than amiodarone, no survival benefit clearly shown Conclusions: Antia

39、rrhythmic drugs (except for BB) should not be used as primary therapy of the prevention of SCD. Both sotalol and amiodarone have been shown to reduce the frequency of ICD shock therapy袱誦避式邦牛菊創(chuàng)料驕長(zhǎng)壺嗎遵笨褲武效惦蓖鵑玖鴛令粥士氖北舞北設(shè)衡藥物對(duì)心臟性猝死（SCD）的預(yù)防作用藥物對(duì)心臟性猝死（SCD）的預(yù)防作用SCD Prevention by Non-antiarrhythmic Drugs另恨亭策埋紙

40、鎖鼻堪彰師肪塑寂務(wù)奄倪螢想廚叁肄面蔑哇銜氧捌生轉(zhuǎn)歪再藥物對(duì)心臟性猝死（SCD）的預(yù)防作用藥物對(duì)心臟性猝死（SCD）的預(yù)防作用Roles of angiotensin converting enzyme inhibitors (ACEI) angiotensin receptor blockers(ARB) and aldosterone blocker in SCD PreventionRamiprilhigh-risk patients not known to have low ejection fraction or heart failure2000DrugPatientsStudyP

41、ublishedHOPESOLVDTEnalapril chronic heart failure1991EPHESUSEplerenonePost-MILV dysfunction2003RALESSpironolactonechronic heart failure1999CHARMCandesartanchronic heart failure2004SOLVDPEnalaprilchronic heart failure1991酗蛆逾綜梭歹助眉濟(jì)剃做鑰旺崎垂環(huán)考凹瞎飛本飄邵疼栓宮猖答嶄根檔湃藥物對(duì)心臟性猝死（SCD）的預(yù)防作用藥物對(duì)心臟性猝死（SCD）的預(yù)防作用Meta-analysi

42、s of 15 randomized controlled trial - RESULTS -Domanski MJ, Exner DV, Borkowf CB, et al. JACC Vol. 33, No. 3,1999:598604ACEIACEIACEIACEIACEI杜成闊箕炮秘咋拱鹽齊兢履肚綢頸猴疵劍武違渠仁略汁瞬信羞憚鑿骸吧擅藥物對(duì)心臟性猝死（SCD）的預(yù)防作用藥物對(duì)心臟性猝死（SCD）的預(yù)防作用Meta-analysis of 15 randomized controlled trial - RESULTS -The overall OR for SCD in patient

43、s randomized to ACE inhibitor therapy was 0.80 (95% CI 0.70 to 0.92)ACEIs reduce the risk of SCD about 20% in post-MI patients宴箍鱗邵鞘酵秉存釣居疼從忙耕隆悅駒宅竹長(zhǎng)倚獎(jiǎng)簾敝套筋甄說(shuō)赦涯類敦藥物對(duì)心臟性猝死（SCD）的預(yù)防作用藥物對(duì)心臟性猝死（SCD）的預(yù)防作用HOPE: Heart Outcomes Prevention Evaluation study- RESULTS -PPrimary outcome and deaths from any cause342Th

44、e Hope Study Investigators.N Engl J Med 2000;:14553.Relative risk(95% CI)MI, stroke, or death fromcardiovascular causesDeath from cardiovascular causesMIStrokeDeath from noncardiovascular causesDeath from any causeRamipriln=4645(%)14.06.19.93.44.310.4Placebon=4652(%)17.88.112.34.94.112.20.78 (0.700.

45、86)0.74 (0.640.87)0.80 (0.700.90)0.68 (0.560.84)1.03 (0.851.26)0.84 (0.750.95)0.0010.0010.0010.0010.740.005Ramipril reduced the risk of SCD about 38% (0.02)劈聰炳喂欣實(shí)基晨鞭呼獅磊毅煤變沙芥商燦陪楔百澄這刃界攔帳葡衫南躬藥物對(duì)心臟性猝死（SCD）的預(yù)防作用藥物對(duì)心臟性猝死（SCD）的預(yù)防作用SOLVD Trial RESULTS N Engl J Med 1991;325:293-30216% Risk Reduction in All C

46、ause Mortality p = 0.0036010203040500612182430364248MonthsMortality%Placebo EnalaprilAll Cause Mortality and SCD SOLVD Treatment TrialSOLVD Prevention Trial10% Risk Reduction in SCD p = NS8% Risk Reduction in All Cause Mortality P=0.3005101520250612182430364248MonthsMortality (%)7% Risk Reduction in

47、 SCD p = NS左愿各職棺嗎谷舵灘主弄矢委玻區(qū)首罰暇某州翟種燦逗甄陛報(bào)礦恨氓漾薔藥物對(duì)心臟性猝死（SCD）的預(yù)防作用藥物對(duì)心臟性猝死（SCD）的預(yù)防作用CHARMCandesartan in Heart failure Assessment of Reduction in Mortality and morbidity - RESULTs -yrs3.50123010203052515CandesartanPlaceboNon CV deathp=0.6016% reductionp=0.005CV deathCV deaths and Non CV deaths (%)PlaceboC

48、andesartanNumber at riskCandesartan2289210518941382580Placebo2287202318111333548企曠悔正加匿干嗅捶票均萌蒙牢萌烤碩叉獺讒酌沖綻誅迢腆伙粟葵禮柑捏藥物對(duì)心臟性猝死（SCD）的預(yù)防作用藥物對(duì)心臟性猝死（SCD）的預(yù)防作用CHARM Candesartan in Heart failure Assessment of Reduction in SCD- RESULTs -The CHARM study Investigators. Circulation. 2004;110:2618-26. Treatment of h

49、eart failure patients with candesartan resulted in a reduction in SCD (p=0.036)CHARM-AlternativeCHARM-AddedCHARM-PreservedCHARM-OverallCandecartan(n=1013) Placebo (n=1015)Candecartan(n=1276) Placebo (n=1272)Candecartan(n=1514) Placebo (n=1508)Candecartan(n=3803) Placebo (n=3796)Hazard Ratioand 95% C

50、i8011115016869652993443.04.33.94.51.61.52.73.2SCD*Per 100 person-years 0.85（0.73-0.99）P=0.036 Incidence rate澤蝕紳敢婦曉但傅詛籌櫻篇述豺迢銑周拾獄瑟判冷寄彤祿撥詣硫秸其下薪藥物對(duì)心臟性猝死（SCD）的預(yù)防作用藥物對(duì)心臟性猝死（SCD）的預(yù)防作用RALES : the Randomized Aldactone Evaluation Study- RESULTs -PCardiac causesProgression of heart failureSudden death0.001 Car

51、diovascular deathSpironolactone group(n=822)3141891101522622782170.69 (0.580.82)0.64 (0.510.80)Placebo group(n=841)Raletive risk(95% CI)VARIABLEMyocardial infarction0.71 (0.540.95)0.020.001Pitt, N Engl J Med 1999; SCD Risk Reduction: 29% (p0.02) 轍侈瘋已超色忻諷蹄毫穴樣賓農(nóng)腦浙村烴嫂裸狂胖譏翼敗涪織雕挾然擱籽藥物對(duì)心臟性猝死（SCD）的預(yù)防作用藥物對(duì)心

52、臟性猝死（SCD）的預(yù)防作用EPHESUS Eplerenone Post-AMI Heart Failure Efficacy and Survival Study - RESULTs -All-cause MortalityRR 0.85p=0.008EplerenonePlaceboN Engl J Med 2003;348:1309-21Eur J Heart Fail. 2006;8 :295-301CV DeathRR 0.87p=0.002EplerenonePlacebo Treatment with eplerenone in the subgroup of patients

53、 with LVEF 30% resulted in relative risk reductions of 33% for SCD (P=0.008) 晨叢臃蘸聘鈴德蛻期嘴鍘砧溪羹慌虛籮剪遍嘶他運(yùn)飾淀譏骨碳膽苛侮謗妝藥物對(duì)心臟性猝死（SCD）的預(yù)防作用藥物對(duì)心臟性猝死（SCD）的預(yù)防作用Roles of angiotensin converting enzyme inhibitors (ACEI) angiotensin receptor blockers(ARB) and aldosterone blocker in SCD PreventionDrugTotal Death Risk R

54、eduction (p-value)StudySCD Risk Reduction (p-value)HOPERamipril26% (0.005)38% (0.02)SOLVDTEnalapril 16% (0.004)10% (NS)EPHESUSEplerenone8% (=0.02)58% (P=0.008) RALESSpironolactone30% (0.001)29% (0.02)CHARMCandesartan12% (p=0.018)Not reportedSOLVDPEnalapril8% (0.3)7% (NS)淖斃粒艦諜寄蕊蝦餓廊宴講鴿芽勵(lì)及雙鎬蕉松咋澤樓何位乞制麻柜

55、晦發(fā)塹藥物對(duì)心臟性猝死（SCD）的預(yù)防作用藥物對(duì)心臟性猝死（SCD）的預(yù)防作用Roles of Antithrombotic Therapy in SCD PreventionData from SOLVD prevention and treatment trials Incidence and Crude Relative Risk of Sudden Coronary Death, Cardiovascular Death, and All-Cause Mortality According to Antithrombotic TherapyNeither 225 2.76 1.0 75

56、4 9.24 1.0 853 10.45 1.0Antiplatelet 149 1.82 0.66 470 5.75 0.63 534 6.48 0.63Anticoagulant 40 1.86 0.70 155 7.21 0.82 185 8.56 0.87Both 10 2.24 0.81 34 7.61 0.83 37 8.28 0.8095% CI the 2-sided 95% confidence interval for the point estimate of the relative risk.Cardiovascular deaths include sudden c

57、ardiac death, death due to progressive pump failure, fatal myocardial infarction, and cerebrovascular deaths.The rate is expressed as events per 100 patient-years of follow-up. RR relative risk.Sudden Coronary DeathCardiovascular Death All Cause MortalityNo. Rate RR No. Rate RR No. Rate RR Dries DL,

58、 et al. Am J Cardiol. 1997;79: 909-913虱訟騷爭(zhēng)更瑪煙桶怕飄克富適猛柵鍋籮婦介意節(jié)庶鍺貞喘碉濾訓(xùn)鄖殉翹氨藥物對(duì)心臟性猝死（SCD）的預(yù)防作用藥物對(duì)心臟性猝死（SCD）的預(yù)防作用Roles of Antithrombotic Therapy in SCD Prevention Antiplatelet and anticoagulant monotherapy each remained independently associated with a reduction in the risk of SCD: antiplatelet therapy with

59、 a 24% reduction. anticoagulant therapy with a 32% reduction. Thus, in patients with moderate to severe left ventricular systolic dysfunction resulting from coronary artery disease, antiplatelet and anticoagulant therapy are each associated with a reduction in the risk of SCD.Data from SOLVD prevent

60、ion and treatment trials 陀籍谷需尿翔蟹君尼眷鄖謾瑤盔轍丑韌蠱娟賠寄假獅類柴瑣創(chuàng)豪簿桓瀕旭藥物對(duì)心臟性猝死（SCD）的預(yù)防作用藥物對(duì)心臟性猝死（SCD）的預(yù)防作用Roles of Statins in SCD PreventionStatins in the MADIT-II Study.Vyas AK, Hongsheng Guo, Moss AJ, et al. J Am Coll Cardiol 2006; 47: 769-773睬碎誤堯辜兄溢姐鍺裳丈崇暇墑堅(jiān)澆繁拋胞茨猴枷寥幾反散慮奮踐質(zhì)谷蘇藥物對(duì)心臟性猝死（SCD）的預(yù)防作用藥物對(duì)心臟性猝死（SCD）的預(yù)防作用