Key result
In patients surviving 5 years after cardiac resynchronization therapy, the risk of late sudden cardiac death was very low and not significantly different between those with and without a defibrillator (HR 1.0).
Why the study?
The very long-term outcome of patients who survive the first few years after cardiac resynchronization therapy has not been well described.
Does CRT-D compared to CRT-P reduce late sudden cardiac death and all-cause mortality in patients with dilated cardiomyopathy who survive 5 years post-implantation?
Cohort (n=1,775)
Yes
Does CRT-D compared to CRT-P reduce late sudden cardiac death and all-cause mortality in patients with dilated cardiomyopathy who survive 5 years post-implantation?
Hazard Ratio: 1 (95% CI 0.45–2.44)
Absolute Event Rate: 5.8% vs 8.5%
In patients surviving 5 years after CRT implantation, sudden cardiac death represents a very low proportion of late mortality, and the addition of a defibrillator (CRT-D) does not significantly improve very long-term survival compared to CRT-P.
AIMS: The very long-term outcome of patients who survive the first few years after receiving cardiac resynchronization therapy (CRT) has not been well described thus far. We aimed to provide long-term outcomes, especially with regard to the occurrence of sudden cardiac death (SCD), in CRT patients without (CRT-P) and with defibrillator (CRT-D). METHODS AND RESULTS: A total of 1775 patients, with ischaemic or non-ischaemic dilated cardiomyopathy, who were alive 5 years after CRT implantation, were enrolled in this multicentre European observational cohort study. Overall long-term mortality rates and specific causes of death were assessed, with a focus on late SCD. Over a mean follow-up of 30 months (interquartile range 10-42 months) beyond the first 5 years, we observed 473 deaths. The annual age-standardized mortality rates of CRT-D and CRT-P patients were 40.4 [95% confidence interval (CI) 35.3-45.5] and 97.2 (95% CI 85.5-109.9) per 1000 patient-years, respectively. The adjusted hazard ratio (HR) for all-cause mortality was 0.99 (95% CI 0.79-1.22). Twenty-nine patients in total died of late SCD (14 with CRT-P, 15 with CRT-D), corresponding to 6.1% of all causes of death in both device groups. Specific annual SCD rates were 8.5 and 5.8 per 1000 patient-years in CRT-P and CRT-D patients, respectively, with no significant difference between groups (adjusted HR 1.0, 95% CI 0.45-2.44). Death due to progressive heart failure represented the principal cause of death (42.8% in CRT-P patients and 52.6% among CRT-D recipients), whereas approximately one-third of deaths in both device groups were due to non-cardiovascular death. CONCLUSION: In this first description of very long-term outcomes among CRT recipients, progressive heart failure death still represented the most frequent cause of death in patients surviving the first 5 years after CRT implant. In contrast, SCD represents a very low proportion of late mortality irrespective of the presence of a defibrillator.
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Barra et al. (2019) conducted a cohort in Ischaemic or non-ischaemic dilated cardiomyopathy (n=1,775). Cardiac resynchronization therapy with defibrillator (CRT-D) vs. Cardiac resynchronization therapy without defibrillator (CRT-P) was evaluated on Late sudden cardiac death (SCD) (HR 1.0, 95% CI 0.45-2.44). In patients surviving 5 years after cardiac resynchronization therapy, the risk of late sudden cardiac death was very low and not significantly different between those with and without a defibrillator (HR 1.0).
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