Time-trend treatment effect of cardiac resynchronization therapy with or without defibrillator on mortality: a systematic review and meta-analysis.

Autor:	Veres B; Heart and Vascular Center, Semmelweis University, Városmajor Str. 68, 1122 Budapest, Hungary.; Center for Translational Medicine, Semmelweis University, Budapest, Hungary., Fehérvári P; Center for Translational Medicine, Semmelweis University, Budapest, Hungary.; Department of Biostatistics, University of Veterinary Medicine, Budapest, Hungary., Engh MA; Center for Translational Medicine, Semmelweis University, Budapest, Hungary., Hegyi P; Center for Translational Medicine, Semmelweis University, Budapest, Hungary.; Institute of Pancreatic Diseases, Semmelweis University, Budapest, Hungary., Gharehdaghi S; Center for Translational Medicine, Semmelweis University, Budapest, Hungary.; Gottsegen György National Cardiovascular Institute, Budapest, Hungary., Zima E; Heart and Vascular Center, Semmelweis University, Városmajor Str. 68, 1122 Budapest, Hungary.; Center for Translational Medicine, Semmelweis University, Budapest, Hungary., Duray G; Center for Translational Medicine, Semmelweis University, Budapest, Hungary.; Central Hospital of Northern Pest-Military Hospital, Budapest, Hungary., Merkely B; Heart and Vascular Center, Semmelweis University, Városmajor Str. 68, 1122 Budapest, Hungary., Kosztin A; Heart and Vascular Center, Semmelweis University, Városmajor Str. 68, 1122 Budapest, Hungary.; Center for Translational Medicine, Semmelweis University, Budapest, Hungary.
Jazyk:	angličtina
Zdroj:	Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology [Europace] 2023 Oct 05; Vol. 25 (10).
DOI:	10.1093/europace/euad289
Abstrakt:	Aims: This study aimed to investigate the impact of cardiac resynchronization therapy with a defibrillator (CRT-D) on mortality, comparing it with CRT with a pacemaker (CRT-P). Additionally, the study sought to identify subgroups, evaluate the time trend in treatment effects, and analyze patient characteristics, considering the changing indications over the past decades. Methods and Results: PubMed, CENTRAL, and Embase up to October 2021 were screened for studies comparing CRT-P and CRT-D, focusing on mortality. Altogether 26 observational studies were selected comprising 128 030 CRT patients, including 55 469 with CRT-P and 72 561 with CRT-D device. Cardiac resynchronization therapy with defibrillator was able to reduce all-cause mortality by almost 20% over CRT-P [adjusted hazard ratio (HR): 0.85; 95% confidence interval (CI): 0.76-0.94; P < 0.01] even in propensity-matched studies (HR: 0.83; 95% CI: 0.80-0.87; P < 0.001) but not in those with non-ischaemic aetiology (HR: 0.95; 95% CI: 0.79-1.15; P = 0.19) or over 75 years (HR: 1.08; 95% CI 0.96-1.21; P = 0.17). When treatment effect on mortality was investigated by the median year of inclusion, there was a difference between studies released before 2015 and those thereafter. Time-trend effects could be also observed in patients' characteristics: CRT-P candidates were getting older and the prevalence of ischaemic aetiology was increasing over time. Conclusion: The results of this systematic review of observational studies, mostly retrospective with meta-analysis, suggest that patients with CRT-D had a lower risk of mortality compared with CRT-P. However, subgroups could be identified, where CRT-D was not superior such as non-ischaemic and older patients. An improved treatment effect of CRT-D on mortality could be observed between the early and late studies partly related to the changed characteristics of CRT candidates. Competing Interests: Conflict of interest: Béla Merkely reports grants from Boston Scientific, NRDIF Hungary, National Heart Program; personal fees from Biotronik, Abbott, Astra Zeneca, Novartis, and Boehringer-Ingelheim; and grants from Medtronic outside the submitted work. Annamária Kosztin reports grants from Bolyai Research Scholarship, consulting fees from Medtronic, personal fees from Biotronic, Boehringer-Ingelheim, Boston Scientific, AstraZeneca, Bayer, and Novartis outside the submitted work, and travel fees from AstraZeneca and Novartis outside the submitted work and reports participation on a Data Safety Monitoring Board or Advisory Board with Boehringer Ingelheim and Boston Scientific outside the submitted work. She is a committee member of the Hungarian Society of Cardiology and the secretary of the Working Group on Cardiac Arrhythmias and Pacing, Hungarian Society of Cardiology outside the submitted work. All other authors declare no competing interests. (© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.)
Databáze:	MEDLINE
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