Long-term clinical outcomes of cardiac resynchronization therapy with or without defibrillation: impact of the aetiology of cardiomyopathy
Key result
Cardiac resynchronization therapy-defibrillation was associated with lower total mortality compared to pacing alone (HR 0.72; P<0.01), with benefit evident in ischaemic but not non-ischaemic aetiology.
Why the study?
Does CRT-D improve survival and reduce hospitalizations compared to CRT-P in patients with primary prevention indications, and does the benefit differ by cardiomyopathy etiology?
Population
1,550 patients receiving primary prevention cardiac resynchronization therapy with ischemic or non-ischemic…
Comparison
Cardiac resynchronization therapy-defibrillation vs Cardiac resynchronization therapy-pacing (CRT-P)
Design
Cohort
Follow-up
median 4.7 years (IQR 2.4-7.1, maximum 16 years)
Authors
Discussion
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Implication
CRT-D may confer survival benefit over CRT-P in NICM; leaves open need for RCTs to guide primary-prevention device choice.
Study Design
Type
Cohort (n=1,550)
Structured PICO
Does CRT-D improve survival and reduce hospitalizations compared to CRT-P in patients with primary prevention indications, and does the benefit differ by cardiomyopathy etiology?
P
Population
1,550 patients with cardiomyopathy receiving cardiac resynchronization therapy with or without defibrillation for primary prevention, followed for a median of 4.7 years.
E
Exposure
Cardiac resynchronization therapy-defibrillation (CRT-D)
C
Comparator
Cardiac resynchronization therapy-pacing (CRT-P)
O
Outcome
Total mortality, composite of total mortality or heart failure hospitalization, and composite of total mortality or hospitalization for major adverse cardiac events (MACE)hard clinical
Main Result
Hazard Ratio: 0.72
p-value: p=<0.01
CRT-D provides a survival benefit over CRT-P in patients with ischemic cardiomyopathy, but not in those with non-ischemic cardiomyopathy.
Cite This Study
Leyva et al. (2018) conducted a cohort in Cardiomyopathy (n=1,550). Cardiac resynchronization therapy-defibrillation (CRT-D) vs. Cardiac resynchronization therapy-pacing (CRT-P) was evaluated on Total mortality (HR 0.72, p=<0.01). Cardiac resynchronization therapy-defibrillation was associated with lower total mortality compared to pacing alone (HR 0.72; P<0.01), with benefit evident in ischaemic but not non-ischaemic aetiology.