M A García García1, M A Rosero Arenas2, R Ruiz Granell3, F J Chorro Gascó4, A Martínez Cornejo1. 1. ICU Sagunto Hospital (Valencia) , Sagunto, Valencia , Spain. 2. C. Salud Cheste (Valencia) , Cheste, Valencia , Spain. 3. Cardiology Service Valencia University Hospital. 4. Cardiology Service Valencia University Hospital; Faculty of Medicine, Department of Medicine, Valencia University. INCLIVA (Research Foundation of the Clinical Hospital of Valencia).
Abstract
AIM: To assess the effectiveness of cardiac resynchronisation therapy (CRT), implantable cardioverter defibrillator (ICD) therapy, and the combination of these devices (CRT+ICD) in adult patients with left ventricular dysfunction and symptomatic heart failure. METHODS: A comprehensive systematic review of randomised clinical trials was conducted. Several electronic databases (PubMed, Embase, Ovid, Cochrane, ClinicalTrials.gov) were reviewed. The mortality rates between treatments were compared. A network was established comparing the various options, and direct, indirect and mixed comparisons were made using multivariate meta-regression. The degree of clinical and statistical homogeneity was assessed. RESULTS: 43 trials involving 13 017 patients were reviewed. Resynchronisation therapy, defibrillators, and combined devices (CRT+ICD) are clearly beneficial compared to optimal medical treatment, showing clear benefit in all of these cases. In a theoretical order of efficiency, the first option is combined therapy (CRT+ICD), the second is CRT, and the third is defibrillator implantation (ICD). Given the observational nature of these comparisons, and the importance of the overlapping CIs, we cannot state that the combined option (CRT+ICD) offers superior survival benefit compared to the other two options. CONCLUSIONS: The combined option of CRT+ICD seems to be better than the option of CRT alone, although no clear improvement in survival was found for the combined option. It would be advisable to perform a direct comparative study of these two options.
AIM: To assess the effectiveness of cardiac resynchronisation therapy (CRT), implantable cardioverter defibrillator (ICD) therapy, and the combination of these devices (CRT+ICD) in adult patients with left ventricular dysfunction and symptomatic heart failure. METHODS: A comprehensive systematic review of randomised clinical trials was conducted. Several electronic databases (PubMed, Embase, Ovid, Cochrane, ClinicalTrials.gov) were reviewed. The mortality rates between treatments were compared. A network was established comparing the various options, and direct, indirect and mixed comparisons were made using multivariate meta-regression. The degree of clinical and statistical homogeneity was assessed. RESULTS: 43 trials involving 13 017 patients were reviewed. Resynchronisation therapy, defibrillators, and combined devices (CRT+ICD) are clearly beneficial compared to optimal medical treatment, showing clear benefit in all of these cases. In a theoretical order of efficiency, the first option is combined therapy (CRT+ICD), the second is CRT, and the third is defibrillator implantation (ICD). Given the observational nature of these comparisons, and the importance of the overlapping CIs, we cannot state that the combined option (CRT+ICD) offers superior survival benefit compared to the other two options. CONCLUSIONS: The combined option of CRT+ICD seems to be better than the option of CRT alone, although no clear improvement in survival was found for the combined option. It would be advisable to perform a direct comparative study of these two options.
Authors: Michael R Bristow; Leslie A Saxon; John Boehmer; Steven Krueger; David A Kass; Teresa De Marco; Peter Carson; Lorenzo DiCarlo; David DeMets; Bill G White; Dale W DeVries; Arthur M Feldman Journal: N Engl J Med Date: 2004-05-20 Impact factor: 91.245
Authors: Anthony S L Tang; George A Wells; Mario Talajic; Malcolm O Arnold; Robert Sheldon; Stuart Connolly; Stefan H Hohnloser; Graham Nichol; David H Birnie; John L Sapp; Raymond Yee; Jeffrey S Healey; Jean L Rouleau Journal: N Engl J Med Date: 2010-11-14 Impact factor: 91.245
Authors: Panos E Vardas; Angelo Auricchio; Jean-Jacques Blanc; Jean-Claude Daubert; Helmut Drexler; Hugo Ector; Maurizio Gasparini; Cecilia Linde; Francisco Bello Morgado; Ali Oto; Richard Sutton; Maria Trusz-Gluza Journal: Eur Heart J Date: 2007-08-28 Impact factor: 29.983