Age-stratified comparison of prognosis in cardiac resynchronization therapy with or without prophylactic defibrillator for nonischemic cardiomyopathy-a nationwide cohort study

被引:1
作者
Farouq, Maiwand [1 ,2 ]
Rorsman, Cecilia [3 ]
Marinko, Sofia [1 ,2 ]
Mortsell, David [1 ,2 ]
Chaudhry, Uzma [1 ,2 ]
Wang, Lingwei [1 ,2 ]
Platonov, Pyotr G. [1 ,2 ]
Borgquist, Rasmus [1 ,2 ]
机构
[1] Lund Univ, Dept Clin Sci, Cardiol, Entregatan 7, S-22185 Lund, Sweden
[2] Skane Univ Hosp, Arrhythm Sect, Traslovsvagen 68, S-43237 Varberg, Sweden
[3] Varberg Hosp, Internal Med Dept, Varberg, Sweden
来源
EUROPACE | 2023年 / 25卷 / 07期
关键词
Heart failure; Pacemaker; Cardiac resynchronization therapy; Prognosis; IMPLANTABLE CARDIOVERTER-DEFIBRILLATOR; PRIMARY PREVENTION; VENTRICULAR-ARRHYTHMIAS; OUTCOMES;
D O I
10.1093/europace/euad187
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Aims Prior studies have suggested that the benefit from primary preventive defibrillator treatment for patients with nonischemic cardiomyopathyy, treated with cardiac resynchronization therapy, may be age-dependent. We aimed to compare age-stratified mortality rates and mode of death in patients with nonischemic cardiomyopathy who are treated with either primary preventive cardiac resynchronization therapy with defibrillator (CRT-D) or CRT with pacemaker (CRT-P). Methods and results All patients with nonischemic cardiomyopathy and CRT-P or primary preventive CRT-D who were implanted in Sweden during the period 2005-2020 were included. Propensity scoring was used to create a matched cohort. Primary outcome was all-cause mortality within 5 years. In all, 4027 patients were included: 2334 with CRT-P and 1693 with CRT-D. Crude 5-year mortality was 635 (27%) vs. 246 (15%), P < 0.001. In Cox regression analysis, adjusted for clinically relevant covariables, CRT-D was independently associated with higher 5-year survival [0.72 (0.61-0.85), P < 0.001]. Cardiovascular mortality was similar between groups (62 vs. 64%, P = 0.64), but death from heart failure was more common in the CRT-D group (46 vs. 36%, P = 0.007). In the matched cohort (n = 2414), 5-year mortality was 21% (24 vs. 16%, P < 0.001). In age-stratified analyses, CRT-P was associated with higher mortality in age groups <60 years and 70-79 years, but there was no difference in age groups 60-69 years or 80-89 years. Conclusion In this nationwide registry-based study, patients with CRT-D had better 5-year survival compared to patients with CRT-P. The interaction between age and mortality reduction was not consistent, but patients with CRT-D aged <60 years had the largest absolute mortality reduction. [GRAPHICS] .
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