Beca Bogdan, Sapp John L, Gardner Martin J, Gray Christopher, AbdelWahab Amir, MacIntyre Ciorsti, Doucette Steve, Parkash Ratika
Division of Medical Education, Dalhousie University, Halifax, Nova Scotia, Canada.
Division of Cardiology, Department of Medicine, Queen Elizabeth II Health Centre, Halifax, Nova Scotia, Canada.
CJC Open. 2019 Mar 6;1(2):93-99. doi: 10.1016/j.cjco.2019.02.002. eCollection 2019 Mar.
Cardiac resynchronization therapy (CRT) is effective in treating advanced heart failure (HF), but data describing benefits and long-term outcomes for upgrades from a preexisting device are limited. This study sought to compare long-term outcomes in de novo CRT implants with those eligible for CRT with a prior device.
This is a retrospective cohort study using data from a provincial registry (2002-2015). Patients were included if they had mild-moderate HF, left ventricular ejection fraction ≤ 35%, and QRS duration ≥ 130 ms. Patients were classified as de novo CRT or upgraded to CRT from a prior device. Outcomes were mortality and composite mortality and HF hospitalization.
There were 342 patients included in the study. In a multivariate model, patients in the upgraded cohort (n = 233) had a higher 5-year mortality rate (adjusted hazard ratio, 2.86; 95% confidence interval, 1.59-5.15; = 0.0005) compared with the de novo cohort (n = 109) and higher composite mortality and HF hospitalization (adjusted hazard ratio, 2.60; 95% confidence interval, 1.54-4.37; = 0.0003).
Implantation of de novo CRTs was associated with lower mortality and HF hospitalization compared with upgraded CRTs from preexisting devices. It is unknown whether these differences are due to the timing of CRT implementation or other clinical factors. Further work in this area may be helpful to determine how to improve outcomes for these patients.
心脏再同步治疗（CRT）对治疗晚期心力衰竭（HF）有效，但关于从现有设备升级的获益和长期结局的数据有限。本研究旨在比较初次植入CRT与有资格从先前设备升级至CRT的患者的长期结局。
这是一项回顾性队列研究，使用省级登记处（2002 - 2015年）的数据。纳入轻度至中度HF、左心室射血分数≤35%且QRS时限≥130 ms的患者。患者分为初次植入CRT或从先前设备升级至CRT。结局为死亡率以及死亡率和HF住院的复合结局。
该研究共纳入342例患者。在多变量模型中，升级队列（n = 233）的患者与初次植入队列（n = 109）相比，5年死亡率更高（调整后风险比为2.86；95%置信区间为1.59 - 5.15；P = 0.0005），死亡率和HF住院的复合结局也更高（调整后风险比为2.60；95%置信区间为1.54 - 4.37；P = 0.0003）。
与从现有设备升级的CRT相比，初次植入CRT与更低的死亡率和HF住院率相关。这些差异是否归因于CRT实施的时机或其他临床因素尚不清楚。该领域的进一步研究可能有助于确定如何改善这些患者的结局。
