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Comparison of de novo and upgrade to resynchronization therapy: a propensity-score matched analysis
Session:
Painel 5 - Arritmologia 8
Speaker:
Mariana Silva Brandão
Congress:
CPC 2020
Topic:
C. Arrhythmias and Device Therapy
Theme:
09. Device Therapy
Subtheme:
09.3 Cardiac Resynchronization Therapy
Session Type:
Posters
FP Number:
---
Authors:
Mariana S. Brandão; João Gonçalves Almeida; Joel Monteiro; Fernando Montenegro Sá; Paulo Fonseca; Filipa Rosas; Elisabeth Santos; José Ribeiro; Marco André Oliveira; Helena Sousa; Pedro Braga; João Primo
Abstract
<p><strong>BACKGROUND:</strong> Upgrade to resynchronization therapy (CRT) is common practice in Europe, but guidelines (GL) are discordant: class I recommendation (Pacing GL) <em>versus</em> IIb (Heart failure (HF) GL). Previous studies suggested worse outcomes in upgraded patients (pts).</p> <p><strong>AIM:</strong> To compare clinical outcomes in a cohort of pts receiving <em>de novo</em> or upgrade to CRT.</p> <p><strong>METHODS</strong>: Single-center retrospective study of consecutive pts submitted to CRT implantation (2007-2017). Major adverse cardiac events (MACE) included HF hospitalization (HHF) or all-cause mortality (ACM). Clinical response was defined as New York Heart Association (NYHA) class improvement without MACE in the 1<sup>st</sup> year of follow-up (FU). Left ventricle end-systolic volume reduction of >15% denoted echocardiographic (echo) response. Survival analysis with Kaplan-Meier method and <em>Log-rank</em> test was performed. Propensity-score matching (PSM) analysis was done to adjust for possible confounder variables.</p> <p><strong>RESULTS:</strong> 230 CRT recipients (70.9% male, mean age 67±11 years, 71.5% non-ischemic cardiomyopathy) were included, of whom 46 (20%) underwent an upgrade. Upgraded pts were older (69.8 <em>vs</em> 65.9 years, p=.015), with more permanent atrial fibrillation (37.0% <em>vs</em> 12.7%, p=.001), moderate to severe valve disease (45.7% <em>vs </em>22.3%, p=.002), chronic kidney disease (37.0% <em>vs </em>17.2%, p=.005) and antimineralocorticoid treatment (79.1% <em>vs</em> 52.0%, p=.002). They were more likely to receive CRT-P (65.2% <em>vs </em>33.2%, p<.001) and CRT-D were more often implanted for secondary prevention (60.0% <em>vs</em> 17.9%, p=.001). </p> <p>No differences emerged in procedural complications, clinical (74.4% <em>vs</em> 71.4%, p=.712) or echo (66.7% <em>vs</em> 69.7%, p=.822) response rates. During a median FU of 3±4 years, ACM was similar among groups (p=.522). There was a statistical tendency for higher MACE rate in the upgrade group (p=.064). No differences were found in lead dislodgement (10.9% <em>vs</em> 7.1%, p=.368) or endocarditis (2.2% <em>vs</em> 4.3%, p=.692) rates. PSM analysis identified 88 matched pairs (46 upgrade/42 <em>de novo</em> pts). In this cohort, ACM (p=.77) and MACE (p=.36) were comparable between groups [graph nº1].</p> <p><strong>CONCLUSION:</strong> In this cohort, upgrade to CRT was similar to <em>de novo </em>implantation in terms of complications and clinical response. The risk for MACE and mortality was also comparable.</p>
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