CRT-D improves survival in non-ischemic CMP, JACC study advocates CRT-D over CRT-P.
The addition of defibrillation support (ICD) in patients undergoing device based cardiac resynchronization therapy (CRT) is well established in ischemic cardiomyopathy (ICMP). But the superiority of CRT-D (CRT PLUS ICD) over CRT-P (pacing alone CRT) in patients with non-ischemic cardiomyopathy (NICM) has always been a grey area in cardiology. Doran et al in their latest published post-hoc analysis of COMPANION trial have shown benefit for the use of CRT-D in patients with advanced NICM who are CRT eligible and illuminate the need for more investigation in this area to provide more precision for ICD recommendations.
Among patients with ICMP, ICDs have been shown to reduce mortality and improve outcomes but there is a question as to whether ICDs are effective in patients with NICM. The DANISH trial did not demonstrate statistically significant improvement in all-cause mortality (ACM) in patients with NICM undergoing ICD implantation; although recent meta-analyses have challenged these results.
COMPANION trial was the first study to demonstrate superiority for major clinical event reduction of CRT over OPT (optimal pharmacological therapy) in patients with HFrEF and intraventricular conduction delays. Doran et al conducted a post-hoc analyses of the COMPANION trial using Cox proportional hazards modeling stratified by HFrEF etiology of nonischemic cardiomyopathy (NICM) or ischemic cardiomyopathy (ICM). The primary outcome was all-cause mortality (ACM), and secondary outcomes were the combination of cardiovascular mortality or heart failure hospitalization and sudden cardiac death.
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