Key result
In patients with nonischemic HFrEF, CRT-D compared to CRT-P was associated with reduced all-cause mortality (adjusted HR 0.54; 95% CI 0.34-0.86), whereas no benefit was seen in ischemic HFrEF.
Why the study?
It was uncertain whether cardiac resynchronization therapy with an ICD compared to without an ICD provides a survival benefit in patients with nonischemic etiologies of HFrEF.
Does CRT-D reduce all-cause mortality compared to CRT-P in patients with HFrEF due to nonischemic cardiomyopathy?
RCT (n=1,212)
Does CRT-D reduce all-cause mortality compared to CRT-P in patients with HFrEF due to nonischemic cardiomyopathy?
Hazard Ratio: 0.54 (95% CI 0.34–0.86)
The addition of a defibrillator to cardiac resynchronization therapy significantly reduces all-cause mortality in HFrEF patients with nonischemic cardiomyopathy, but not in those with ischemic cardiomyopathy.
CRT-D was associated with lower mortality than CRT-P in nonischemic HFrEF; hypothesis-generating, should not yet change practice.
OBJECTIVES: The aim of this study was to determine whether patients with heart failure with reduced ejection fraction (HFrEF) due to nonischemic etiology eligible for cardiac resynchronization therapy (CRT) benefit from an implantable cardioverter-defibrillator (ICD). BACKGROUND: It is uncertain whether CRT with an ICD (CRT-D) compared to without an ICD (CRT-P) is associated with a survival benefit in patients with nonischemic etiologies of HFrEF. METHODS: Analyses of the COMPANION (Comparison of Medical Therapy, Pacing, and Defibrillation in Heart Failure) trial were performed, using Cox proportional hazards modeling stratified by HFrEF etiology of nonischemic cardiomyopathy (NICM) or ischemic cardiomyopathy (ICM). The primary outcome was all-cause mortality (ACM), and secondary outcomes were the combination of cardiovascular mortality or heart failure hospitalization and sudden cardiac death. RESULTS: = 0.040 unadjusted). In patients with NICM (n = 555), CRT-D versus CRT-P was associated with reduced ACM (adjusted HR: 0.54; 95% CI: 0.34 to 0.86), while patients with ICM (n = 657) did not exhibit a between-device reduction in ACM (adjusted HR: 1.05; 95% CI: 0.77 to 1.44). The effects of CRT-D versus CRT-P on sudden cardiac death (advantage CRT-D) and cardiovascular mortality or heart failure hospitalization (no difference between CRT-P and CRT-D) were similar between the 2 HFrEF etiologies. CONCLUSIONS: COMPANION patients with NICM exhibited a decrease in ACM associated with CRT-D but not CRT-P treatment, whereas patients with ICM did not.
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Doran et al. (2021) conducted an RCT in Heart failure with reduced ejection fraction (HFrEF) (n=1,212). CRT with an ICD (CRT-D) vs. CRT without an ICD (CRT-P) was evaluated on All-cause mortality (ACM) (adjusted HR 0.54, 95% CI 0.34 to 0.86). In patients with nonischemic HFrEF, CRT-D compared to CRT-P was associated with reduced all-cause mortality (adjusted HR 0.54; 95% CI 0.34-0.86), whereas no benefit was seen in ischemic HFrEF.
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