Abstract
Randomized control trials comparing the effectiveness of cardiac resynchronization therapy devices, with (CRT-D) or without (CRT-P) a defibrillator, are scarce in heart failure patients. Patients with nonischemic dilated cardiomyopathy (NICM) may be at lower risk for ventricular arrhythmias compared with those with ischemic cardiomyopathy. In addition, NICM has been identified as a predictor of positive response to CRT. The aim of this study was to investigate the impact of an additional implantable cardioverter-defibrillator over CRT in Korean patients with NICM.
During the period from January 1, 2008 to December 31, 2017, 533 NICM patients (mean age, 65.7±12.2 years, male 53.6%) with newly-implanted CRT-P (n=71) or CRT-D (n=462) who were aged 19 years or older were identified by 50-percents random sampling from the Korean National Health Insurance Service database.
Compared with patients receiving CRT-P, those receiving CRT-D were younger (65.3±12.3 vs. 68.3±11.6 years, p=0.038), more likely to be male (56.1% vs. 38.0%, p=0.005), and have an admission history of congestive heart failure (93.9% vs. 87.3%, p=0.041). Over the mean follow-up period of 21 months,114 cases in the CRT-D group and 24 cases in the CRT-P group died, with annualized mortality rates of 14.9 and 17.2 per 100 person-years, respectively. Kaplan-Meier estimates of event-free survival showed that there was no difference in mortality between CRT-D and CRT-P groups (p=0.343). In multivariate analysis, factors associated with mortality were chronic kidney disease, atrial fibrillation, and older age. With regard to death or heart failure hospitalization, heart failure death, and non-cardiac death, there were no difference between the two groups.
Among Asian patients with NICM with indications for CRT, death, death or heart failure hospitalization, heart failure death, and non-cardiac death were not different between CRT-D and CRT-P groups.
Type of funding source: None
