Key result
Epicardial implantation of a CRT system concomitant with CABG significantly reduced 18-month mortality compared to CABG alone (10% vs 26.1%, p=0.006) and improved LV systolic function.
Why the study?
Does epicardial implantation of a CRT system during CABG reduce mortality and improve LV function in patients with ischaemic HF and LV dyssynchrony?
Cohort (n=178)
Does epicardial implantation of a CRT system during CABG reduce mortality and improve LV function in patients with ischaemic HF and LV dyssynchrony?
Absolute Event Rate: 10% vs 26.1%
p-value: p=0.006
Concomitant epicardial CRT implantation during CABG in patients with ischemic HF and LV dyssynchrony significantly reduces 18-month mortality and improves LV function and quality of life compared to CABG alone.
May support epicardial CRT during CABG in ischemic HF with dyssynchrony; leaves open randomized confirmation.
OBJECTIVE: We have tested the hypothesis that epicardial implantation of cardiac resynchronisation therapy (CRT) system during coronary artery bypass grafting (CABG) may be an additional treatment method, which can decrease the mortality and improve left ventricle (LV) systolic function in patients with ischaemic heart failure (HF) and LV dyssynchrony. METHODS: One hundred and seventy-eight consecutive patients with severe ischaemic HF and LV dyssynchrony were enrolled in two groups: CABG alone (n=87) and epicardial CRT implantation during CABG (n=91). The primary end point of the study was the comparison of mortality between two groups at 18 months of follow-up. RESULTS: Twenty-three patients (26.1%) in the CABG group died at 18 months of follow-up compared with nine (10%) in CABG+CRT group (log-rank test, p=0.006). The Cox regression analysis revealed that LV dyssynchrony (hazard ratio (HR) 2.634 (1.206-5.751), p=0.015) was the independent predictor of all-cause death and HF hospitalisation. LV systolic function, dyssynchrony signs and quality of life did not change significantly post-CABG compared to pre-CABG data in CABG group patients. On the contrary, echocardiography revealed an improved LV ejection fraction (42±1.9 vs 28±2.7; p<0.001), smaller LV end-systolic volume (120±57.5 vs 164±61.4; p=0.04) and improved LV synchrony in the CABG+CRT group compared with the CABG group. In the CABG+CRT group, more patients improved by two NYHA classes (NYHA, New York Heart Association; 49 vs 0; p=0.028), had a longer 6-min-walk test distance (452±65 vs 289±72; p<0.001) and a better quality of life (22.9±5 vs 46.4±11; p<0.001) compared with the CABG group. CONCLUSION: For majority of the patients with ischaemic HF and evidence of LV dyssynchrony, CABG neither eliminates dyssynchrony nor improves systolic function. Epicardial implantation of a CRT system concomitant with CABG facilitates patient management in the early postoperative period, improves LV systolic function and quality of life and is associated with low mortality at 18 months of follow-up.
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Pokushalov et al. (2010) conducted a cohort in ischaemic heart failure and left ventricular dyssynchrony (n=178). Epicardial cardiac resynchronisation therapy (CRT) implantation during CABG vs. CABG alone was evaluated on mortality at 18 months of follow-up (p=0.006). Epicardial implantation of a CRT system concomitant with CABG significantly reduced 18-month mortality compared to CABG alone (10% vs 26.1%, p=0.006) and improved LV systolic function.
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