Sex Differences in Device Therapies for Ventricular Arrhythmias or Death in the Multicenter Automatic Defibrillator Implantation Trial With Cardiac Resynchronization Therapy (MADIT-CRT) Trial.
BACKGROUND
Studies suggest that women with ischemic heart disease are less likely to experience appropriate ICD therapies for ventricular arrhythmias (VT/VF). We evaluated the influence of sex on arrhythmic events or death in subjects enrolled in MADIT-CRT.


RESULTS
Arrhythmic event rates, defined as VT/VF treated with defibrillator therapy or all-cause death, were determined among 1,790 subjects enrolled in MADIT-CRT with documented 3-year follow-up. Predictors of VT/VF/death were identified using multivariate analysis. Ninety-one (21%) women and 466 (35%) men experienced VT/VF/death over the follow-up period. The overall probability of VT/VF/death was significantly lower in women versus men (HR 0.62; P < 0.001). The probability of VT/VF/death was the lowest in women with ischemic heart disease (HR 0.51; P = 0.003). In ICD subjects, the 3-year risk of VT/VF was lower in ischemic women versus men (P = 0.021), and in nonischemic women versus men (P = 0.049). The probability of VT/VF/death was significantly lower in women (HR 0.52; P = 0.007) and men (HR 0.74; P = 0.018) with LBBB who received CRT-D. Appropriate shock therapy strongly correlated with increased risk of death during postshock follow-up in women (HR 5.18; P = 0.001) and men (HR 1.63; P = 0.033); interaction P value of 0.034.


CONCLUSIONS
In this substudy of MADIT-CRT, sex, etiology of heart disease and type of device implanted significantly influenced subsequent risk for VT/VF or death. Women with ischemic heart disease and women with LBBB who received CRT-D had the lowest incidence of VT/VF or death when compared to men. Appropriate shock therapy was a strong predictor of death, particularly in women.
School of Medicine, University of Colorado, Aurora, Colorado, USA.
Christine M
CM
Tompkins
Heart Research Follow-Up Program, University of Rochester Medical Center, Rochester, New York, USA.
Valentina
V
Kutyifa
Valley Health System, Columbia University, New York, USA.
Aysha
A
Arshad
Heart Research Follow-Up Program, University of Rochester Medical Center, Rochester, New York, USA.
Scott
S
McNitt
Heart Research Follow-Up Program, University of Rochester Medical Center, Rochester, New York, USA.
Bronislava
B
Polonsky
Stanford University of Medicine, Palo Alto, California, USA.
Paul J
PJ
Wang
Heart Research Follow-Up Program, University of Rochester Medical Center, Rochester, New York, USA.
Arthur J
AJ
Moss
Heart Research Follow-Up Program, University of Rochester Medical Center, Rochester, New York, USA.
Wojciech
W
Zareba
D000368:Aged; D058406:Cardiac Resynchronization Therapy / Q000009:adverse effects / Q000401:mortality; D058409:Cardiac Resynchronization Therapy Devices; D016009:Chi-Square Distribution; D016757:Death, Sudden, Cardiac / Q000209:etiology / Q000517:prevention & control*; D017147:Defibrillators, Implantable; D004554:Electric Countershock / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D005260:Female; D054624:Health Status Disparities; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011474:Prosthesis Design; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors; D017180:Tachycardia, Ventricular / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D014693:Ventricular Fibrillation / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*
MADIT-CRT; cardiac resynchronization therapy; gender differences; heart failure; outcomes; ventricular fibrillation; ventricular tachycardia