RESUMO
OBJECTIVES: The purpose of this multicenter randomized trial was to compare total mortality during therapy with amiodarone or an implantable cardioverter-defibrillator (ICD) in patients with nonischemic dilated cardiomyopathy (NIDCM) and nonsustained ventricular tachycardia (NSVT). BACKGROUND: Whether an ICD reduces mortality more than amiodarone in patients with NIDCM and NSVT is unknown. METHODS: One hundred three patients with NIDCM, left ventricular ejection fraction < or =0.35, and asymptomatic NSVT were randomized to receive either amiodarone or an ICD. The primary end point was total mortality. Secondary end points included arrhythmia-free survival, quality of life, and costs. RESULTS: The study was stopped when the prospective stopping rule for futility was reached. The percent of patients surviving at one year (90% vs. 96%) and three years (88% vs. 87%) in the amiodarone and ICD groups, respectively, were not statistically different (p = 0.8). Quality of life was also similar with each therapy (p = NS). There was a trend with amiodarone, as compared to the ICD, towards improved arrhythmia-free survival (p = 0.1) and lower costs during the first year of therapy ($8,879 US dollars vs. $22,039 US dollars, p = 0.1). CONCLUSIONS: Mortality and quality of life in patients with NIDCM and NSVT treated with amiodarone or an ICD are not statistically different. There is a trend towards a more beneficial cost profile and improved arrhythmia-free survival with amiodarone therapy.
Assuntos
Amiodarona/uso terapêutico , Antiarrítmicos/uso terapêutico , Cardiomiopatia Dilatada/complicações , Desfibriladores Implantáveis , Taquicardia Ventricular/prevenção & controle , Amiodarona/efeitos adversos , Amiodarona/economia , Antiarrítmicos/efeitos adversos , Antiarrítmicos/economia , Cardiomiopatia Dilatada/economia , Cardiomiopatia Dilatada/mortalidade , Custos e Análise de Custo , Desfibriladores Implantáveis/efeitos adversos , Desfibriladores Implantáveis/economia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Taxa de Sobrevida , Taquicardia Ventricular/complicações , Taquicardia Ventricular/economia , Taquicardia Ventricular/mortalidadeRESUMO
A 67-year-old man was admitted with unstable angina, 15 years after saphenous vein graft bypass surgery. Cardiac catheterization demonstrated a large saccular aneurysm arising from the proximal segment of the vein graft to the obtuse marginal artery. Intravascular ultrasound revealed the opening of the aneurysm that measured 15 mm in length. The aneurysm was successfully occluded by deployment of a vein-covered stent.
