The Addition of a Defibrillator to Resynchronization Therapy Decreases Mortality in Patients With Nonischemic Cardiomyopathy.
cardiac resynchronization therapy
heart failure with reduced ejection fraction
implantable cardioverter-defibrillator
nonischemic cardiomyopathy
Journal
JACC. Heart failure
ISSN: 2213-1787
Titre abrégé: JACC Heart Fail
Pays: United States
ID NLM: 101598241
Informations de publication
Date de publication:
06 2021
06 2021
Historique:
received:
10
02
2021
accepted:
19
02
2021
pubmed:
17
5
2021
medline:
29
10
2021
entrez:
16
5
2021
Statut:
ppublish
Résumé
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). 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. 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. Among patients randomized to CRT (n = 1,212), 236 (19.5%) died, 131 and 105 in the CRT-P and CRT-D arms, respectively. The unadjusted and adjusted hazard ratios (HRs) for CRT-D versus CRT-P were both 0.84 (95% confidence interval [CI]: 0.65 to 1.09) for ACM, with a significant device-etiology interaction (p COMPANION patients with NICM exhibited a decrease in ACM associated with CRT-D but not CRT-P treatment, whereas patients with ICM did not.
Sections du résumé
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
Among patients randomized to CRT (n = 1,212), 236 (19.5%) died, 131 and 105 in the CRT-P and CRT-D arms, respectively. The unadjusted and adjusted hazard ratios (HRs) for CRT-D versus CRT-P were both 0.84 (95% confidence interval [CI]: 0.65 to 1.09) for ACM, with a significant device-etiology interaction (p
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.
Identifiants
pubmed: 33992570
pii: S2213-1779(21)00119-0
doi: 10.1016/j.jchf.2021.02.013
pii:
doi:
Types de publication
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
439-449Commentaires et corrections
Type : CommentIn
Informations de copyright
Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.
Déclaration de conflit d'intérêts
Funding Support and Author Disclosures This analysis was supported by the Statistical Data Analysis Center at the University of Wisconsin, by the University of Colorado Division of Cardiology, and by an American Heart Association Strategically Focused Network Grant in Heart Failure awarded to Drs. Bristow and Buttrick. The corporate sponsor of the COMPANION trial, Boston Scientific, provided no funding to the study. Drs. Feldman, Saxon, and Bristow were consultants for Guidant Corporation during the planning and execution of the COMPANION trial. Drs. Doran and Bristow are supported by an American Heart Association Strategically Focused Network Grant in Heart Failure. Dr. DeMets is a founder of the Statistical Data Analysis Center at the University of Wisconsin, where he is an emeritus professor. The Statistical and Data Analysis Center provided biostatistical support for the analyses performed by Mr. Mei in the current study. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.