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Causes-of-death analysis of patients with cardiac resynchronization therapy: an analysis of the CeRtiTuDe cohort study

Eloi Marijon 1, 2 Christophe Leclercq 3, 4 Kumar Narayanan 2 Serge Boveda 5 Didier Klug 6 Jonathan Lacaze-Gadonneix 1 Pascal Defaye 7 Sophie Jacob 8 Olivier Piot 9 Jean-Claude Deharo 10 Marie-Cécile Perier 11 Genevieve Mulak 12 Jean-Sylvain Hermida 13 Paul Milliez 14 Daniel Gras 15 Olivier Cesari 16 Françoise Hidden-Lucet 17, 18 Frederic Anselme 19 Philippe Chevalier 20 Philippe Maury 21 Nicolas Sadoul 22 Pierre Bordachar 23 Serge Cazeau 24 Michel Chauvin 25 Jean-Philippe Empana 2 Xavier Jouven 2 Jean-Claude Daubert 4, 3 Jean-Yves Le Heuzey 2
Abstract : AIMS: The choice of resynchronization therapy between with (CRT-D) and without (CRT-P) a defibrillator remains a contentious issue. Cause-of-death analysis among CRT-P, compared with CRT-D, patients could help evaluate the extent to which CRT-P patients would have additionally benefited from a defibrillator in a daily clinical practice. METHODS AND RESULTS: A total of 1705 consecutive patients implanted with a CRT (CRT-P: 535 and CRT-D: 1170) between 2008 and 2010 were enrolled in CeRtiTuDe, a multicentric prospective follow-up cohort study, with specific adjudication for causes of death at 2 years. Patients with CRT-P compared with CRT-D were older (P \textless 0.0001), less often male (P \textless 0.0001), more symptomatic (P = 0.0005), with less coronary artery disease (P = 0.003), wider QRS (P = 0.002), more atrial fibrillation (P \textless 0.0001), and more co-morbidities (P = 0.04). At 2-year follow-up, the annual overall mortality rate was 83.80 [95% confidence interval (CI) 73.41-94.19] per 1000 person-years. The crude mortality rate among CRT-P patients was double compared with CRT-D (relative risk 2.01, 95% CI 1.56-2.58). In a Cox proportional hazards regression analysis, CRT-P remained associated with increased mortality (hazard ratio 1.54, 95% CI 1.07-2.21, P = 0.0209), although other potential confounders may persist. By cause-of-death analysis, 95% of the excess mortality among CRT-P subjects was related to an increase in non-sudden death. CONCLUSION: When compared with CRT-D patients, excess mortality in CRT-P recipients was mainly due to non-sudden death. Our findings suggest that CRT-P patients, as currently selected in routine clinical practice, would not potentially benefit with the addition of a defibrillator
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Eloi Marijon, Christophe Leclercq, Kumar Narayanan, Serge Boveda, Didier Klug, et al.. Causes-of-death analysis of patients with cardiac resynchronization therapy: an analysis of the CeRtiTuDe cohort study. European Heart Journal, Oxford University Press (OUP): Policy B, 2015, 36 (41), pp.2767--2776. ⟨10.1093/eurheartj/ehv455⟩. ⟨hal-01263258⟩

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