PhD Scientific Days 2021

Budapest, 7-8 July 2021

CL_I_P: Clinical Medicine I. Posters

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

1. Boglarka Veres MD., Heart and Vascular Center, Semmelweis University, Budapest
2. Walter Richard Schwertner MD., Heart and Vascular Center, Semmelweis University, Budapest
3. Luca Kuthi MD., Heart and Vascular Center, Semmelweis University, Budapest
4. Anett Behon MD., Heart and Vascular Center, Semmelweis University, Budapest
5. Eperke Merkel MD., Heart and Vascular Center, Semmelweis University, Budapest
6. István Osztheimer MD. PhD., Heart and Vascular Center, Semmelweis University, Budapest
7. Endre Zima MD. PhD. DSC., Heart and Vascular Center, Semmelweis University, Budapest
8. László Gellér MD. PhD. DSc., Heart and Vascular Center, Semmelweis University, Budapest
9. Roland Papp MD., Heart and Vascular Center, Semmelweis University, Budapest
10. Attila Kovács MD. PhD., Heart and Vascular Center, Semmelweis University, Budapest
11. Annamária Kosztin MD. PhD., Heart and Vascular Center, Semmelweis University, Budapest
12. Béla Merkely MD. PhD. DSc., Heart and Vascular Center, Semmelweis University, Budapest

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