TY - JOUR
T1 - Time-dependent benefit of preventive cardiac resynchronization therapy after myocardial infarction
AU - Barsheshet, Alon
AU - Moss, Arthur J.
AU - Eldar, Michael
AU - Huang, David T.
AU - Hall, W. Jackson
AU - Klein, Helmut U.
AU - McNitt, Scott
AU - Steinberg, Jonathan S.
AU - Wilber, David J.
AU - Zareba, Wojciech
AU - Goldenberg, Ilan
N1 - Funding Information:
The MADIT-CRT study was supported by a research grant from Boston Scientific, St Paul, Minnesota to the University of Rochester School of Medicine and Dentistry.
PY - 2011/7
Y1 - 2011/7
N2 - AimsCardiac remodelling is a progressive process after myocardial infarction (MI). However, currently there are no data regarding the effect of elapsed time from MI on the benefit of cardiac resynchronization therapy with defibrillator (CRT-D). The present study was designed to evaluate the relationship between elapsed time from MI and the benefit of preventive CRT-D therapy in patients with ischaemic cardiomyopathy (ICM).Methods and resultsThe risk of heart failure (HF) or death as a function of elapsed time from MI to enrolment, by treatment with CRT-D vs. implantable cardioverter defibrillator (ICD)-only therapy, was assessed among 704 ICM patients with a documented MI enrolled in MADIT-CRT, and separately in a subset of ICM patients without a documented prior MI (n=237). In ICD patients, the adjusted risk of HF or death increased by 4 (P 0.01) for each year elapsed from MI. Multivariate analysis demonstrated that patients with remote MI [categorized at the median value (<8 years)] derived a significantly greater benefit from CRT-D [HR 0.42 (P < 0.001)] than those with a more recent MI [HR 1.26 (P=0.35); P-value for interaction <0.001]. Consistently, the benefit of CRT-D was directly related to increasing quartiles of elapsed time from MI [Q 1 (<3 years): HR= 1.67; P=0.20, Q 2 (38 years): HR =1.12; P=0.71, Q 3 (8-15 years): HR=0.47; P=0.02, and Q 4 (<15 years): HR =0.38; P= 0.001]. The ICM subgroup with no documented MI also derived enhanced benefit from CRT-D (HR= 0.43; P= 0.003).ConclusionIn patients with ischaemic cardiomyopathy, the risk of HF or death and the magnitude of CRT-D benefit are directly related to elapsed time from MI.
AB - AimsCardiac remodelling is a progressive process after myocardial infarction (MI). However, currently there are no data regarding the effect of elapsed time from MI on the benefit of cardiac resynchronization therapy with defibrillator (CRT-D). The present study was designed to evaluate the relationship between elapsed time from MI and the benefit of preventive CRT-D therapy in patients with ischaemic cardiomyopathy (ICM).Methods and resultsThe risk of heart failure (HF) or death as a function of elapsed time from MI to enrolment, by treatment with CRT-D vs. implantable cardioverter defibrillator (ICD)-only therapy, was assessed among 704 ICM patients with a documented MI enrolled in MADIT-CRT, and separately in a subset of ICM patients without a documented prior MI (n=237). In ICD patients, the adjusted risk of HF or death increased by 4 (P 0.01) for each year elapsed from MI. Multivariate analysis demonstrated that patients with remote MI [categorized at the median value (<8 years)] derived a significantly greater benefit from CRT-D [HR 0.42 (P < 0.001)] than those with a more recent MI [HR 1.26 (P=0.35); P-value for interaction <0.001]. Consistently, the benefit of CRT-D was directly related to increasing quartiles of elapsed time from MI [Q 1 (<3 years): HR= 1.67; P=0.20, Q 2 (38 years): HR =1.12; P=0.71, Q 3 (8-15 years): HR=0.47; P=0.02, and Q 4 (<15 years): HR =0.38; P= 0.001]. The ICM subgroup with no documented MI also derived enhanced benefit from CRT-D (HR= 0.43; P= 0.003).ConclusionIn patients with ischaemic cardiomyopathy, the risk of HF or death and the magnitude of CRT-D benefit are directly related to elapsed time from MI.
KW - Cardiac resynchronization therapy
KW - Heart failure
KW - Myocardial infarction
UR - http://www.scopus.com/inward/record.url?scp=79960021781&partnerID=8YFLogxK
U2 - 10.1093/eurheartj/ehq392
DO - 10.1093/eurheartj/ehq392
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AN - SCOPUS:79960021781
SN - 0195-668X
VL - 32
SP - 1614
EP - 1621
JO - European Heart Journal
JF - European Heart Journal
IS - 13
ER -