Time-dependent benefit of preventive cardiac resynchronization therapy after myocardial infarction

Alon Barsheshet*, Arthur J. Moss, Michael Eldar, David T. Huang, W. Jackson Hall, Helmut U. Klein, Scott McNitt, Jonathan S. Steinberg, David J. Wilber, Wojciech Zareba, Ilan Goldenberg

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


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.

Original languageEnglish
Pages (from-to)1614-1621
Number of pages8
JournalEuropean Heart Journal
Issue number13
StatePublished - Jul 2011
Externally publishedYes


  • Cardiac resynchronization therapy
  • Heart failure
  • Myocardial infarction


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