Juha S Perkiomaki1, Anne-Christine Ruwald2, Valentina Kutyifa3, Martin H Ruwald2, Scott Mcnitt3, Bronislava Polonsky3, Robert E Goldstein4, Mark C Haigney4, Ronald J Krone5, Wojciech Zareba3, Arthur J Moss3. 1. Cardiology Unit, Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA Medical Research Center Oulu, Oulu University Hospital and University of Oulu, P.O. Box 5000 (Kajaanintie 50), FIN-90014 Oulu, Finland juha.perkiomaki@oulu.fi. 2. Cardiology Unit, Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA Department of Cardiology, Gentofte Hospital, Hellerup, Denmark. 3. Cardiology Unit, Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA. 4. Cardiology Division, Uniformed Services University of Health Sciences, Bethesda, MD, USA. 5. Division of Cardiology, Washington University School of Medicine, St. Louis, MO, USA.
Abstract
AIMS: To understand modes of death and factors associated with the risk for cardiac and non-cardiac deaths in patients with cardiacresynchronization therapy with implantable cardioverter-defibrillator (CRT-D) vs. implantable cardioverter-defibrillator (ICD) therapy, which may help clarify the action and limitations of cardiac resynchronization therapy (CRT) in relieving myocardial dysfunction. METHODS AND RESULTS: In Multicenter Automatic Defibrillator Implantation Trial-Cardiac Resynchronization Therapy (MADIT-CRT), during 4 years of follow-up, 169 (9.3%) of 1820 patients died of known causes, 108 (63.9%) deemed cardiac, and 61 (36.1%) non-cardiac. In multivariate analysis, increased baseline creatinine was significantly associated with both cardiac and non-cardiac deaths [hazard ratio (HR) 2.97, P < 0.001; HR 1.80, P = 0.035, respectively], as was diabetes (HR 1.79, P = 0.006; HR 1.73, P = 0.038, respectively), and the worst New York Heart Association Class > II more than 3 months prior to enrolment (HR 1.90, P = 0.012; HR 2.46, P = 0.010, respectively). Baseline left atrial volume index was significantly associated only with cardiac mortality (HR 1.28 per 5 unit increase, P < 0.001). Ischaemic cardiomyopathy was associated only with non-cardiac death (HR 3.54, P = 0.001). CRT-D vs. an ICD-only was associated with a reduced risk for cardiac death in patients with left bundle branch block (LBBB) (HR 0.56, P = 0.029) but was associated with an increased risk for non-cardiac death in non-LBBB patients (HR 3.48, P = 0.048). CONCLUSIONS: In MADIT-CRT, two-thirds of the deaths were cardiac and one-third non-cardiac. Many of the same risk factors were associated with both cardiac and non-cardiac mortalities. CRT-D was associated with a reduced risk for cardiac death in LBBB but an increased risk for non-cardiac death in non-LBBB. CLINICAL TRIAL REGISTRATION: Information for the MADIT-CRT main study http://www.clinicaltrials.gov, NCT00180271. Published on behalf of the European Society of Cardiology. All rights reserved.
RCT Entities:
AIMS: To understand modes of death and factors associated with the risk for cardiac and non-cardiac deaths in patients with cardiac resynchronization therapy with implantable cardioverter-defibrillator (CRT-D) vs. implantable cardioverter-defibrillator (ICD) therapy, which may help clarify the action and limitations of cardiac resynchronization therapy (CRT) in relieving myocardial dysfunction. METHODS AND RESULTS: In Multicenter Automatic Defibrillator Implantation Trial-Cardiac Resynchronization Therapy (MADIT-CRT), during 4 years of follow-up, 169 (9.3%) of 1820 patients died of known causes, 108 (63.9%) deemed cardiac, and 61 (36.1%) non-cardiac. In multivariate analysis, increased baseline creatinine was significantly associated with both cardiac and non-cardiac deaths [hazard ratio (HR) 2.97, P < 0.001; HR 1.80, P = 0.035, respectively], as was diabetes (HR 1.79, P = 0.006; HR 1.73, P = 0.038, respectively), and the worst New York Heart Association Class > II more than 3 months prior to enrolment (HR 1.90, P = 0.012; HR 2.46, P = 0.010, respectively). Baseline left atrial volume index was significantly associated only with cardiac mortality (HR 1.28 per 5 unit increase, P < 0.001). Ischaemic cardiomyopathy was associated only with non-cardiac death (HR 3.54, P = 0.001). CRT-D vs. an ICD-only was associated with a reduced risk for cardiac death in patients with left bundle branch block (LBBB) (HR 0.56, P = 0.029) but was associated with an increased risk for non-cardiac death in non-LBBB patients (HR 3.48, P = 0.048). CONCLUSIONS: In MADIT-CRT, two-thirds of the deaths were cardiac and one-third non-cardiac. Many of the same risk factors were associated with both cardiac and non-cardiac mortalities. CRT-D was associated with a reduced risk for cardiac death in LBBB but an increased risk for non-cardiac death in non-LBBB. CLINICAL TRIAL REGISTRATION: Information for the MADIT-CRT main study http://www.clinicaltrials.gov, NCT00180271. Published on behalf of the European Society of Cardiology. All rights reserved.
Authors: Antti O Vuoti; Mikko P Tulppo; Olavi H Ukkola; M Juhani Junttila; Heikki V Huikuri; Antti M Kiviniemi; Juha S Perkiömäki Journal: PLoS One Date: 2021-07-02 Impact factor: 3.240
Authors: Giacomo Tini; Edoardo Bertero; Alessio Signori; Maria Pia Sormani; Christoph Maack; Rudolf A De Boer; Marco Canepa; Pietro Ameri Journal: J Am Heart Assoc Date: 2020-08-31 Impact factor: 5.501