Key result
In older patients with non-ischemic cardiomyopathy, CRT pacemakers were associated with similar all-cause mortality compared to CRT defibrillators (adjusted HR 0.95; 95% CI 0.47-1.89).
Why the study?
Does CRT-P compared to CRT-D improve survival in older (≥75 years) patients with non-ischemic cardiomyopathy?
Cohort (n=135)
No
Does CRT-P compared to CRT-D improve survival in older (≥75 years) patients with non-ischemic cardiomyopathy?
Hazard Ratio: 0.95 (95% CI 0.47–1.89)
Absolute Event Rate: 33% vs 43%
In older patients (≥75 years) with non-ischemic cardiomyopathy, the addition of a defibrillator to cardiac resynchronization therapy does not improve survival compared to a pacemaker alone.
CRT-P may suffice for survival in older non-ischemic cardiomyopathy; hypothesis-generating and requires randomized confirmation before practice change.
INTRODUCTION: With the recent publication of the negative DANISH trial, the mortality benefit of the implantable cardioverter-defibrillator (ICD) has been put in question in patients with non-ischemic cardiomyopathy (NICM). Because a majority of patients in DANISH receive cardiac resynchronization therapy (CRT) devices, we investigated in the present study the survival of recipients of CRT pacemakers (CRT-P) versus CRT ICDs (CRT-D) in a cohort of older (≥75 years) NICM patients at our institution. METHODS: A total of 135 NICM patients with CRT device were identified (42 with CRT-P and 93 with CRT-D) and were followed to the endpoint of all-cause mortality. Overall survival was compared between the CRT-P and CRT-D groups with adjustment for differences in baseline characteristics. RESULTS: Over a median follow-up of 46 months from the time of CRT device implantation, there were 54 total deaths (40%): 14 in the CRT-P (33%) and 40 in the CRT-D (43%) groups. Overall, CRT-P recipients had similar unadjusted mortality compared to CRT-D recipients (hazard ratio [HR] 1.04, 95% confidence interval [CI] 0.56-1.93), and this remained unchanged after adjusting for unbalanced covariates (HR 0.95, 95% CI 0.47-1.89) including left ventricular ejection fraction, used of angiotensin converting enzyme inhibitors/angiotensin receptor blockers, and the Charlson comorbidity index. CONCLUSION: Our data support that in older NICM patients with CRT devices, the addition of ICD therapy does not improve survival.
No takes yet. Share an insight, caveat, or question.
Wang et al. (2018) conducted a cohort in non-ischemic cardiomyopathy (n=135). CRT pacemakers (CRT-P) vs. CRT defibrillators (CRT-D) was evaluated on all-cause mortality (HR 0.95, 95% CI 0.47-1.89). In older patients with non-ischemic cardiomyopathy, CRT pacemakers were associated with similar all-cause mortality compared to CRT defibrillators (adjusted HR 0.95; 95% CI 0.47-1.89).
Synapse has enriched 4 closely related papers on similar clinical questions. Consider them for comparative context: