Effectiveness of cardiac resynchronization therapy by the frequency of revascularization procedures in ischemic cardiomyopathy patients

Mustafa Husaini, Yitschak Biton, Brad Stair, Arthur J. Moss, Tor Biering-Sørensen, Scott Solomon, Scott McNitt, Bronislava Polonsky, Wojciech Zareba, Alon Barsheshet, Valentina Kutyifa

Research output: Contribution to journalArticlepeer-review

3 Scopus citations

Abstract

Background: It is not known whether the number of revascularizations modifies clinical outcomes in patients with ischemic cardiomyopathy (ICM) implanted with cardiac resynchronization therapy defibrillator (CRT-D) vs. an implantable cardioverter-defibrillator (ICD)-only.Methods: In Multicenter Automatic Defibrillator Implantation Trial-Cardiac Resynchronization Therapy (MADIT-CRT), we evaluated the effect of CRT-D vs. ICD-only on heart failure (HF) or death, on ventricular tachycardia (VT), ventricular fibrillation (VF) or death, and on reverse remodeling in 592 ICM patients with left bundle branch block, by the number of pre-enrollment revascularizations (0, 1 or ≥ 2 revascularizations).Results: There was a risk reduction of HF/death with CRT-D vs. ICD-only in all three sub-groups: ICM with no need for revascularization (HR 0.51 [0.26-1.02]; p = 0.055), ICM with 1 revascularization (HR 0.45 [0.30-0.70]; p < 0.001), and ICM with 2 or more revascularizations (HR 0.37 [0.20-0.66]; p < 0.001). Similarly, there was a risk reduction of VT/ /VF/death with CRT-D vs. ICD-only in patients with no need for revascularization (HR 0.55 [0.31-0.99]; p = 0.044); with 1 revascularization (HR 0.77 [0.51-1.18]; p = 0.23); or with = 2 revascularizations (HR 0.63 [0.34-1.17]; p = 0.14). There was a similar degree of left ventricular reverse remodeling in all three sub-groups (p > 0.05 for LVESV, LVEDV, and LAV percent change at 1-year follow-up).Conclusions: In ICM patients, CRT-D is associated with a reduction in HF or death and VT/VF or death - irrespective of the frequency of pre-enrollment revascularization procedures - and is accompanied by a similar degree of beneficial left ventricular reverse remodeling.

Original languageEnglish
Pages (from-to)437-445
Number of pages9
JournalCardiology Journal
Volume23
Issue number4
DOIs
StatePublished - 2016
Externally publishedYes

Keywords

  • Cardiac resynchronization therapy
  • Heart failure
  • Implantable cardioverter-defibrillator
  • Ventricular tachyarrhythmias

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