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Causes-of-death analysis of patients with cardiac resynchronization therapy: an analysis of the CeRtiTuDe cohort study

2015; Oxford University Press; Volume: 36; Issue: 41 Linguagem: Inglês

10.1093/eurheartj/ehv455

1522-9645

Éloi Marijon, Christophe Leclercq, Kumar Narayanan, Serge Bovéda, Didier Klug, Jonathan Lacaze-Gadonneix, Pascal Defaye, Sophie Jacob, Olivier Piot, Jean‐Claude Deharo, Marie‐Cécile Perier, Geneviève Mulak, Alexis Hermida, Paul Milliez, Daniel Gras, Olivier Césari, Françoise Hidden‐Lucet, Frédéric Anselme, Philippe Chevalier, Philippe Maury, Nicolas Sadoul, Pierre Bordachar, Serge Cazeau, Michel Chauvin, Jean‐Philippe Empana, Xavier Jouven, Jean‐Claude Daubert, Jean‐Yves Le Heuzey,

Cardiac electrophysiology and arrhythmias

The choice of resynchronization therapy between with (CRT-D) and without (CRT-P) a defibrillator remains a contentious issue. Cause-of-death analysis among CRT-P, compared with CRT-D, patients could help evaluate the extent to which CRT-P patients would have additionally benefited from a defibrillator in a daily clinical practice.A total of 1705 consecutive patients implanted with a CRT (CRT-P: 535 and CRT-D: 1170) between 2008 and 2010 were enrolled in CeRtiTuDe, a multicentric prospective follow-up cohort study, with specific adjudication for causes of death at 2 years. Patients with CRT-P compared with CRT-D were older (P < 0.0001), less often male (P < 0.0001), more symptomatic (P = 0.0005), with less coronary artery disease (P = 0.003), wider QRS (P = 0.002), more atrial fibrillation (P < 0.0001), and more co-morbidities (P = 0.04). At 2-year follow-up, the annual overall mortality rate was 83.80 [95% confidence interval (CI) 73.41-94.19] per 1000 person-years. The crude mortality rate among CRT-P patients was double compared with CRT-D (relative risk 2.01, 95% CI 1.56-2.58). In a Cox proportional hazards regression analysis, CRT-P remained associated with increased mortality (hazard ratio 1.54, 95% CI 1.07-2.21, P = 0.0209), although other potential confounders may persist. By cause-of-death analysis, 95% of the excess mortality among CRT-P subjects was related to an increase in non-sudden death.When compared with CRT-D patients, excess mortality in CRT-P recipients was mainly due to non-sudden death. Our findings suggest that CRT-P patients, as currently selected in routine clinical practice, would not potentially benefit with the addition of a defibrillator.