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Meta-analysis comparing cardiac resynchronization therapy with or without defibrillation in patients with non-ischemic cardiomyopathy
Session:
Comunicações Orais - Sessão 16 - Pacing cardíaco
Speaker:
Vanda Neto
Congress:
CPC 2024
Topic:
C. Arrhythmias and Device Therapy
Theme:
09. Device Therapy
Subtheme:
09.6 Device Therapy - Other
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Vanda Devesa Neto; Gonçalo Costa; Luis Ferreira Santos; António Costa; Rogério Teixeira; Lino Gonçalves
Abstract
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:"Times New Roman",serif">Background:</span></strong><span style="font-family:"Times New Roman",serif"> Cardiac resynchronization therapy (CRT) stands as a notable medical breakthrough for individuals with heart failure and electrical desynchrony. This intervention aims to alleviate symptoms, diminish hospitalization rates, and enhance overall survival, both in conjunction with and without implantable cardioverter-defibrillator (ICD) therapy. Despite these advancements, the role of defibrillator therapy in conjunction with CRT for patients with non-ischemic cardiomyopathy (NICM) remains a topic of debate. </span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:"Times New Roman",serif">Objective:</span></strong><span style="font-family:"Times New Roman",serif"> To assess and compare the outcomes of individuals diagnosed with NICM who have underwent CRT with implantable cardioverter-defibrillator (CRT-D) against those who received CRT with a pacemaker only (CRT-P).</span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="background-color:white"><span style="font-family:"Times New Roman",serif"><span style="color:#212529">Methods:</span></span></span></strong><span style="background-color:white"><span style="font-family:"Times New Roman",serif"><span style="color:#212529"> We conducted a systematic searched of PubMed, Embase and Cochrane database </span></span></span><span style="font-family:"Times New Roman",serif"><span style="color:black">during August 2023 for studies comparing CRT-P and CRT-D in patients with nonischemic cardiomyopathy.</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:"Times New Roman",serif"><span style="color:#0f0f0f">Results:</span></span></strong><span style="font-family:"Times New Roman",serif"><span style="color:#0f0f0f"> Thirteen studies, including two randomized clinical trials, were incorporated, with a total of 61,326 patients providing 16,446 pooled death events (9,108 in CRT-D and 7,338 in CRT-P). The meta-analysis revealed that CRT-D was associated with a significantly lower risk of all-cause mortality compared to CRT-P (pooled HR 0.74; 95% CI: 0.62-0.88; I2=84%), resulting in a 26% reduction in mortality risk. Subgroup analysis focusing on propensity score-matched studies yielded consistent findings (pooled HR 0.82; 95% CI: 0.77-0.87; I² = 0%). However, subgroup analysis for patients older than 75 years suggested no statistically significant difference in mortality risk within this specific age group (pooled HR 0.96; 95% CI: 0.811-1.15; I² = 39%). Regarding the secondary endpoint of cardiovascular mortality, no significant risk reduction with CRT-D was observed (pooled HR 0.70; 95% CI: 0.49-1.01; I² = 92%).</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="background-color:white"><span style="font-family:"Times New Roman",serif"><span style="color:#212529">Conclusion:</span></span></span></strong> <span style="font-family:"Times New Roman",serif"><span style="color:#0f0f0f">Our meta-analysis indicates that the addition of defibrillator therapy significantly reduces all-cause mortality in CRT-eligible patients with NICM, although results were not consistent for patients older than 75 years</span></span><span style="font-family:"Segoe UI",sans-serif"><span style="color:#0f0f0f">.</span></span></span></span></p>
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