Survival with cardiac-resynchronization therapy in mild heart failure

Ilan Goldenberg, Valentina Kutyifa, Helmut U. Klein, David S. Cannom, Mary W. Brown, Ariela Dan, James P. Daubert, N. A.Mark Estes, Elyse Foster, Henry Greenberg, Josef Kautzner, Robert Klempfner, Malte Kuniss, Bela Merkely, Marc A. Pfeffer, Aurelio Quesada, Sami Viskin, Scott McNitt, Bronislava Polonsky, Ali GhanemScott D. Solomon, David Wilber, Wojciech Zareba, Arthur J. Moss

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189 Citations (Scopus)

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; P<0.001). 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 bundlebranch block (adjusted hazard ratio for death from any cause, 1.57; 95% CI, 1.03 to 2.39; P = 0.04; P<0.001 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.)

Original languageEnglish
Pages (from-to)1694-1701
Number of pages8
JournalNew England Journal of Medicine
Volume370
Issue number18
DOIs
Publication statusPublished - 2014

ASJC Scopus subject areas

  • Medicine(all)

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    Goldenberg, I., Kutyifa, V., Klein, H. U., Cannom, D. S., Brown, M. W., Dan, A., Daubert, J. P., Estes, N. A. M., Foster, E., Greenberg, H., Kautzner, J., Klempfner, R., Kuniss, M., Merkely, B., Pfeffer, M. A., Quesada, A., Viskin, S., McNitt, S., Polonsky, B., ... Moss, A. J. (2014). Survival with cardiac-resynchronization therapy in mild heart failure. New England Journal of Medicine, 370(18), 1694-1701. https://doi.org/10.1056/NEJMoa1401426