Risk factors and the effect of cardiac resynchronization therapy on cardiac and non-cardiac mortality in MADIT-CRT

Juha S. Perkiomaki, Anne Christine Ruwald, Valentina Kutyifa, Martin H. Ruwald, Scott Mcnitt, Bronislava Polonsky, Robert E. Goldstein, Mark C. Haigney, Ronald J. Krone, Wojciech Zareba, Arthur J. Moss

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Abstract

Aims To understand modes of death and factors associated with the risk for cardiac and non-cardiac deaths in patients with cardiac resynchronization therapy with implantable cardioverter-defibrillator (CRT-D) vs. implantable cardioverter-defibrillator (ICD) therapy, which may help clarify the action and limitations of cardiac resynchronization therapy (CRT) in relieving myocardial dysfunction. Methods and results In Multicenter Automatic Defibrillator Implantation Trial-Cardiac Resynchronization Therapy (MADIT-CRT), during 4 years of follow-up, 169 (9.3%) of 1820 patients died of known causes, 108 (63.9%) deemed cardiac, and 61 (36.1%) non-cardiac. In multivariate analysis, increased baseline creatinine was significantly associated with both cardiac and non-cardiac deaths [hazard ratio (HR) 2.97, P < 0.001; HR 1.80, P = 0.035, respectively], as was diabetes (HR 1.79, P = 0.006; HR 1.73, P = 0.038, respectively), and the worst New York Heart Association Class > II more than 3 months prior to enrolment (HR 1.90, P = 0.012; HR 2.46, P = 0.010, respectively). Baseline left atrial volume index was significantly associated only with cardiac mortality (HR 1.28 per 5 unit increase, P < 0.001). Ischaemic cardiomyopathy was associated only with non-cardiac death (HR 3.54, P = 0.001). CRT-D vs. an ICD-only was associated with a reduced risk for cardiac death in patients with left bundle branch block (LBBB) (HR 0.56, P = 0.029) but was associated with an increased risk for non-cardiac death in non-LBBB patients (HR 3.48, P = 0.048). Conclusions In MADIT-CRT, two-thirds of the deaths were cardiac and one-third non-cardiac. Many of the same risk factors were associated with both cardiac and non-cardiac mortalities. CRT-D was associated with a reduced risk for cardiac death in LBBB but an increased risk for non-cardiac death in non-LBBB. Clinical Trial Registration Information for the MADIT-CRT main study http://www.clinicaltrials.gov, NCT00180271.

Original languageEnglish
Pages (from-to)1816-1822
Number of pages7
JournalEuropace
Volume17
Issue number12
DOIs
StatePublished - Nov 10 2015

Keywords

  • Cardiac resynchronization therapy
  • Causes of death
  • Heart failure
  • Implantable cardioverter-defibrillators
  • Ischaemic cardiomyopathy
  • Non-ischaemic cardiomyopathy

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    Perkiomaki, J. S., Ruwald, A. C., Kutyifa, V., Ruwald, M. H., Mcnitt, S., Polonsky, B., Goldstein, R. E., Haigney, M. C., Krone, R. J., Zareba, W., & Moss, A. J. (2015). Risk factors and the effect of cardiac resynchronization therapy on cardiac and non-cardiac mortality in MADIT-CRT. Europace, 17(12), 1816-1822. https://doi.org/10.1093/europace/euv201