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- Title
Long-Term Results of Cardiac Resynchronization Therapy: A Comparison between CRT-Pacemakers versus Primary Prophylactic CRT-Defibrillators.
- Authors
REITAN, CHRISTIAN; CHAUDHRY, UZMA; BAKOS, ZOLTAN; BRANDT, JOHAN; WANG, LINGWEI; PLATONOV, PYOTR G.; BORGQUIST, RASMUS
- Abstract
Background Cardiac resynchronization therapy (CRT) with or without a defibrillator has a positive effect on mortality and morbidity for patients with heart failure. However, comparisons between CRT-defibrillators (CRT-D) and CRT-pacemakers (CRT-P) are relatively scarce outside the clinical trial setting. This study aimed to assess baseline characteristics in relation to long-term prognosis in patients treated with CRT, and to investigate the potential benefit of CRT-D versus CRT-P. Methods Data were retrospectively collected from the medical records of all consecutive patients treated with CRT-P or primary prophylactic CRT-D at a large tertiary care center between 1999 and 2012. Predictors of mortality were investigated, and time-dependent analysis was performed with all-cause mortality as the primary end point. Results A total of 705 patients were included (69.6 ± 10 years, 78% New York Heart Association classes III-IV, left ventricular ejection fraction median 25%, 16% female, 36% CRT-D). The patients were followed for a median of 59 months. Annual mortality differed between CRT-D primary prophylactic and CRT-P groups (5.3% and 11.8%, respectively), but when adjusted for covariates, CRT-D treatment (compared to CRT-P) was not associated with better long-term survival. Independent predictors of survival were: age, use of loop diuretics, hemoglobin levels, and use of renin angiotensin aldosterone system blockers. Conclusions In CRT treatment outside of the clinical trial setting, CRT-D treatment was not an independent predictor of long-term survival. Future research should focus on correct selection of the patients who receive enough benefit of an added defibrillator to justify CRT-D implantation instead of CRT-P treatment only.
- Subjects
CARDIAC pacemakers; CARDIAC pacing; CHI-squared test; CONFIDENCE intervals; FISHER exact test; IMPLANTABLE cardioverter-defibrillators; RESEARCH funding; SEX distribution; SURVIVAL analysis (Biometry); T-test (Statistics); TREATMENT effectiveness; PROPORTIONAL hazards models; RETROSPECTIVE studies; DATA analysis software; DESCRIPTIVE statistics; KAPLAN-Meier estimator; MANN Whitney U Test; KRUSKAL-Wallis Test
- Publication
Pacing & Clinical Electrophysiology, 2015, Vol 38, Issue 6, p758
- ISSN
0147-8389
- Publication type
Article
- DOI
10.1111/pace.12631