PhD Scientific Days 2021

CL_I_P: Clinical Medicine I. Posters

Long-term mortality benefit of adding an ICD to CRT in non-ischemic patients

Text of the abstract

Aims: Data is incomprehensive about the long-term mortality benefit of Cardiac Resynchronization Therapy with (CRT-D) or without (CRT-P) a defibrillator. We aimed to assess the long-term all-cause mortality benefit of CRT-D compared to CRT-P by ischemic etiology.
Method: Between 2000 and 2018, patients after a successful CRT implantation were registered. From 2524 patients, 1099 (44%) had CRT-P and 1366 (54%) CRT-D implantation. Those 59 (2%) patients, who had an ICD upgrade with a CRT-P device during the follow-up, were excluded from the current analysis. The primary composite endpoint was all-cause mortality, LVAD implantation, or heart transplantation. Kaplan-Meier and multivariate Cox regressional analyses were used to evaluate all-cause mortality in the total cohort and by ischemic etiology.
Results: During the median follow-up time of 3,6 years, 1389 patients died from any cause, 697 patients (50%) with a CRT-P, 692 patients (50%) with a CRT-D device. By multivariate analysis, etiology, gender, functional class, renal function, and the presence of ICD were independent predictors of all-cause mortality in the total cohort. By multivariate analysis, patients with a CRT-D device showed a 25% decreased risk of long-term mortality compared to CRT-P alone (aHR 0.75; 95%CI 0.58-0.97; p=0.03). When patients were dichotomized by their etiology, those with non-ischemic cardiomyopathy showed a long-term benefit from ICD even after adjusting for relevant clinical variables (aHR 0.45; 95%CI 0.28-0.72; p<0.01). Despite having a clear mortality benefit of ICD during the mid-term follow-up in ischemic patients, it is decreasing after 5 years and less pronounced after adjusting for clinical variables (aHR 0.92; 95%CI 0.67-1.27; p=0.60).
Conclusion: However, during mid-term follow-up, CRT-D had a clear mortality benefit in ischemic patients compared to CRT-P alone, after 5 years it became less pronounced. While in patients with non-ischemic cardiomyopathy, the benefit of adding an ICD to CRT lasts over 10 years.

Funding: Financed by the Development of scientific workshops of medical, health sciences, and pharmaceutical educations projects (EFOP-3.6.3-VEKOP-16-2017-000099), Semmelweis University.

University and Doctoral School

Semmelweis University, Doctoral School of Theoretical and Translational Medicine