Survival with Cardiac-Resynchronization Therapy in Mild Heart Failure Journal Article

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Authors: Goldenberg, I; Kutyifa, V.; Klein, H. U.; Cannom, D. S.; Brown, M. W.; Dan, A.; Daubert, J. P.; Estes, N. A., 3rd; Foster, E.; Greenberg, H.; Kautzner, J.; Klempfner, R; Kuniss, M.; Merkely, B.; Pfeffer, M. A.; Quesada, A.; Viskin, S.; McNitt, S.; Polonsky, B.; Ghanem, A.; Solomon, S. D.; Wilber, D; Zareba, W.; Moss, A. J.
Article Title: Survival with Cardiac-Resynchronization Therapy in Mild Heart Failure
Abstract: Background The Multicenter Automatic Defibrillator Implantation Trial with Cardiac Resynchronization Therapy (MADIT-CRT) showed that early intervention with cardiac-resynchronization therapy with a defibrillator (CRT-D) in patients with an electrocardiographic pattern showing left bundle-branch block was associated with a significant reduction in heart-failure events over a median follow-up of 2.4 years, as compared with defibrillator therapy alone. Methods We evaluated the effect of CRT-D on long-term survival in the MADIT-CRT population. Post-trial follow-up over a median period of 5.6 years was assessed among all 1691 surviving patients (phase 1) and subsequently among 854 patients who were enrolled in post-trial registries (phase 2). All reported analyses were performed on an intention-to-treat basis. Results At 7 years of follow-up after initial enrollment, the cumulative rate of death from any cause among patients with left bundle-branch block was 18% among patients randomly assigned to CRT-D, as compared with 29% among those randomly assigned to defibrillator therapy alone (adjusted hazard ratio in the CRT-D group, 0.59; 95% confidence interval [CI], 0.43 to 0.80; P0.001). The long-term survival benefit of CRT-D in patients with left bundle-branch block did not differ significantly according to sex, cause of cardiomyopathy, or QRS duration. In contrast, CRT-D was not associated with any clinical benefit and possibly with harm in patients without left bundle-branch block (adjusted hazard ratio for death from any cause, 1.57; 95% CI, 1.03 to 2.39; P=0.04; P0.001 for interaction of treatment with QRS morphologic findings). Conclusions Our findings indicate that in patients with mild heart-failure symptoms, left ventricular dysfunction, and left bundle-branch block, early intervention with CRT-D was associated with a significant long-term survival benefit. (Funded by Boston Scientific; ClinicalTrials.gov numbers, NCT00180271 , NCT01294449 , and NCT02060110 .).
Journal Title: The New England journal of medicine
ISSN: 1533-4406; 0028-4793
Publisher: Unknown  
Date Published: 2014
Language: ENG
DOI/URL:

10.1056/NEJMoa1401426
Notes: JID: 0255562; aheadofprint