Key result
Cardiac resynchronization therapy with a defibrillator (CRT-D) had lower unadjusted mortality than CRT-P (55 vs 97 deaths per 1000 patient-years), with SCD causing one third of the excess.
Why the study?
Does CRT-D reduce sudden cardiac death and all-cause mortality compared to CRT-P in patients receiving cardiac resynchronization therapy?
Meta-Analysis (n=18,874)
Does CRT-D reduce sudden cardiac death and all-cause mortality compared to CRT-P in patients receiving cardiac resynchronization therapy?
Absolute Event Rate: 55% vs 97%
CRT-P is associated with a nearly two-fold higher unadjusted mortality rate compared to CRT-D, with sudden cardiac death accounting for a third of the excess mortality, particularly in males, ischemic cardiomyopathy, and NYHA class 3 patients.
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Higher mortality with CRT-P (only one-third excess from SCD) warrants individualized selection; extends observational data but leaves RCTs needed.
Barra et al. (2017) conducted a meta-analysis in Heart failure requiring cardiac resynchronization therapy (n=18,874). Cardiac resynchronization therapy with a defibrillator (CRT-D) vs. Cardiac resynchronization therapy without a defibrillator (CRT-P) was evaluated on All-cause mortality (deaths per 1000 patient-years). Cardiac resynchronization therapy with a defibrillator (CRT-D) had lower unadjusted mortality than CRT-P (55 vs 97 deaths per 1000 patient-years), with SCD causing one third of the excess.
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