Long-term clinical outcomes after upgrade to resynchronization therapy: A propensity score–matched analysis
Background: Upgrade to cardiac resynchronization therapy (CRT) is common in Europe, despite little and conflicting evidence. Objective: To compare long-term clinical outcomes in a cohort of patients receiving de novo or upgrade to CRT. Methods: Single-center retrospective study of 295 consecutive pa...
| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2021-12-01
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| Series: | Heart Rhythm O2 |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666501821001574 |
| _version_ | 1819095386499842048 |
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| author | Mariana Brandão, MD, MSc João Gonçalves Almeida, MD, MSc Paulo Fonseca, MD, MSc Joel Monteiro, MD, MSc Elisabeth Santos, MSc Filipa Rosas, MSc José Nogueira Ribeiro, MSc Marco Oliveira, MD, MSc Helena Gonçalves, MD, MSc João Primo, MD, MSc Ricardo Fontes-Carvalho, MD, PhD |
| author_facet | Mariana Brandão, MD, MSc João Gonçalves Almeida, MD, MSc Paulo Fonseca, MD, MSc Joel Monteiro, MD, MSc Elisabeth Santos, MSc Filipa Rosas, MSc José Nogueira Ribeiro, MSc Marco Oliveira, MD, MSc Helena Gonçalves, MD, MSc João Primo, MD, MSc Ricardo Fontes-Carvalho, MD, PhD |
| author_sort | Mariana Brandão, MD, MSc |
| collection | DOAJ |
| description | Background: Upgrade to cardiac resynchronization therapy (CRT) is common in Europe, despite little and conflicting evidence. Objective: To compare long-term clinical outcomes in a cohort of patients receiving de novo or upgrade to CRT. Methods: Single-center retrospective study of 295 consecutive patients submitted to CRT implantation between 2007 and 2018. Upgraded and de novo patients complying with a dedicated follow-up protocol were compared in terms of clinical (NYHA class improvement without major adverse cardiac events [MACE] in the first year of follow-up) and echocardiographic (left ventricle end-systolic volume reduction of >15% during the first year) response. Results: No differences in the rate of clinical (59.3% vs 62.6%, P = .765) or echocardiographic response (72.2% vs 71.9%, P = .970) between groups were observed. Device-related complications were also comparable between groups (8.9% vs 8.4%, P = .892). Occurrence of MACE and all-cause mortality were analyzed over a median follow-up of 3 (interquartile range 1–6) years: MACE occurred less frequently in the de novo group (hazard ratio [HR]: 0.55, 95% confidence interval [CI]: 0.34–0.90, P = .018), but all-cause mortality was similar among groups (HR: 0.87, 95% CI: 0.46–1.64, P = .684). Propensity score–matching analysis was performed to adjust for possible confounder variables. In the propensity-matched samples, all-cause mortality (HR: 1.26, 95% CI: 0.56–2.77, P = .557) and MACE (HR: 0.84, 95% CI: 0.46–1.54, P = .574) were comparable between upgrade and de novo patients. Conclusion: Survival after upgrade to resynchronization therapy was comparable to de novo implants. Additionally, clinical and echocardiographic response to CRT in upgraded patients were similar to de novo patients. |
| first_indexed | 2024-12-21T23:42:29Z |
| format | Article |
| id | doaj.art-403d9ff601e74437a53ded40982ae2b6 |
| institution | Directory Open Access Journal |
| issn | 2666-5018 |
| language | English |
| last_indexed | 2024-12-21T23:42:29Z |
| publishDate | 2021-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Heart Rhythm O2 |
| spelling | doaj.art-403d9ff601e74437a53ded40982ae2b62022-12-21T18:46:12ZengElsevierHeart Rhythm O22666-50182021-12-0126671679Long-term clinical outcomes after upgrade to resynchronization therapy: A propensity score–matched analysisMariana Brandão, MD, MSc0João Gonçalves Almeida, MD, MSc1Paulo Fonseca, MD, MSc2Joel Monteiro, MD, MSc3Elisabeth Santos, MSc4Filipa Rosas, MSc5José Nogueira Ribeiro, MSc6Marco Oliveira, MD, MSc7Helena Gonçalves, MD, MSc8João Primo, MD, MSc9Ricardo Fontes-Carvalho, MD, PhD10Cardiology Department, Centro Hospitalar de Vila Nova de Gaia, Vila Nova de Gaia, Portugal; Address reprint requests and correspondence: Dr Mariana Brandão, Centro Hospitalar Vila Nova de Gaia/Espinho, Rua Conceição Fernandes S/N, 4434-502, Vila Nova de Gaia, Portugal.Cardiology Department, Centro Hospitalar de Vila Nova de Gaia, Vila Nova de Gaia, PortugalCardiology Department, Centro Hospitalar de Vila Nova de Gaia, Vila Nova de Gaia, PortugalCardiology Department, Centro Hospitalar do Tâmega e Sousa, Penafiel, PortugalCardiology Department, Centro Hospitalar de Vila Nova de Gaia, Vila Nova de Gaia, PortugalCardiology Department, Centro Hospitalar de Vila Nova de Gaia, Vila Nova de Gaia, PortugalCardiology Department, Centro Hospitalar de Vila Nova de Gaia, Vila Nova de Gaia, PortugalCardiology Department, Centro Hospitalar de Vila Nova de Gaia, Vila Nova de Gaia, PortugalCardiology Department, Centro Hospitalar de Vila Nova de Gaia, Vila Nova de Gaia, PortugalCardiology Department, Centro Hospitalar de Vila Nova de Gaia, Vila Nova de Gaia, PortugalCardiology Department, Centro Hospitalar de Vila Nova de Gaia, Vila Nova de Gaia, PortugalBackground: Upgrade to cardiac resynchronization therapy (CRT) is common in Europe, despite little and conflicting evidence. Objective: To compare long-term clinical outcomes in a cohort of patients receiving de novo or upgrade to CRT. Methods: Single-center retrospective study of 295 consecutive patients submitted to CRT implantation between 2007 and 2018. Upgraded and de novo patients complying with a dedicated follow-up protocol were compared in terms of clinical (NYHA class improvement without major adverse cardiac events [MACE] in the first year of follow-up) and echocardiographic (left ventricle end-systolic volume reduction of >15% during the first year) response. Results: No differences in the rate of clinical (59.3% vs 62.6%, P = .765) or echocardiographic response (72.2% vs 71.9%, P = .970) between groups were observed. Device-related complications were also comparable between groups (8.9% vs 8.4%, P = .892). Occurrence of MACE and all-cause mortality were analyzed over a median follow-up of 3 (interquartile range 1–6) years: MACE occurred less frequently in the de novo group (hazard ratio [HR]: 0.55, 95% confidence interval [CI]: 0.34–0.90, P = .018), but all-cause mortality was similar among groups (HR: 0.87, 95% CI: 0.46–1.64, P = .684). Propensity score–matching analysis was performed to adjust for possible confounder variables. In the propensity-matched samples, all-cause mortality (HR: 1.26, 95% CI: 0.56–2.77, P = .557) and MACE (HR: 0.84, 95% CI: 0.46–1.54, P = .574) were comparable between upgrade and de novo patients. Conclusion: Survival after upgrade to resynchronization therapy was comparable to de novo implants. Additionally, clinical and echocardiographic response to CRT in upgraded patients were similar to de novo patients.http://www.sciencedirect.com/science/article/pii/S2666501821001574Cardiac resynchronization therapyUpgradeHeart failurePacemakerImplantable cardioverter-defibrillator |
| spellingShingle | Mariana Brandão, MD, MSc João Gonçalves Almeida, MD, MSc Paulo Fonseca, MD, MSc Joel Monteiro, MD, MSc Elisabeth Santos, MSc Filipa Rosas, MSc José Nogueira Ribeiro, MSc Marco Oliveira, MD, MSc Helena Gonçalves, MD, MSc João Primo, MD, MSc Ricardo Fontes-Carvalho, MD, PhD Long-term clinical outcomes after upgrade to resynchronization therapy: A propensity score–matched analysis Heart Rhythm O2 Cardiac resynchronization therapy Upgrade Heart failure Pacemaker Implantable cardioverter-defibrillator |
| title | Long-term clinical outcomes after upgrade to resynchronization therapy: A propensity score–matched analysis |
| title_full | Long-term clinical outcomes after upgrade to resynchronization therapy: A propensity score–matched analysis |
| title_fullStr | Long-term clinical outcomes after upgrade to resynchronization therapy: A propensity score–matched analysis |
| title_full_unstemmed | Long-term clinical outcomes after upgrade to resynchronization therapy: A propensity score–matched analysis |
| title_short | Long-term clinical outcomes after upgrade to resynchronization therapy: A propensity score–matched analysis |
| title_sort | long term clinical outcomes after upgrade to resynchronization therapy a propensity score matched analysis |
| topic | Cardiac resynchronization therapy Upgrade Heart failure Pacemaker Implantable cardioverter-defibrillator |
| url | http://www.sciencedirect.com/science/article/pii/S2666501821001574 |
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