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


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 < 0.0001), less often male (P < 0.0001), more symptomatic (P = 0.0005), with less coronary artery disease (P = 0.003), wider QRS (P = 0.002), more atrial fibrillation (P < 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.


CONCLUSIONS
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.
Cardiology Department, European Georges Pompidou Hospital, Paris, France Paris Descartes University, Paris, France Paris Cardiovascular Research Centre, Paris, France.
Eloi
E
Marijon
Pontchaillou University Hospital and INSERM 1099, CIC-IT 804 Rennes, France.
Christophe
C
Leclercq
Paris Cardiovascular Research Centre, Paris, France.
Kumar
K
Narayanan
Clinique Pasteur, Toulouse, France.
Serge
S
Boveda
Lille University Hospital and University of Lille, Lille, France.
Didier
D
Klug
Cardiology Department, European Georges Pompidou Hospital, Paris, France Paris Descartes University, Paris, France.
Jonathan
J
Lacaze-Gadonneix
Arrhythmia Department, University Hospital, Grenoble, France.
Pascal
P
Defaye
Epidemiology Unit, IRSN, Paris, France.
Sophie
S
Jacob
Centre Cardiologique du Nord, Saint Denis, France.
Olivier
O
Piot
Cardiology Division, Hôpital La Timone, Marseille, France.
Jean-Claude
JC
Deharo
Paris Cardiovascular Research Centre, Paris, France.
Marie-Cecile
MC
Perier
French Society of Cardiology, Paris, France.
Genevieve
G
Mulak
Amiens University Hospital, Amiens, France.
Jean-Sylvain
JS
Hermida
Caen University Hospital, Caen, France.
Paul
P
Milliez
Nouvelles Cliniques Nantaises, Nantes, France.
Daniel
D
Gras
Clinique Saint Gatien, Tours, France.
Olivier
O
Cesari
Cardiology Department, La Pitié-Salpêtrière Hospital, AP-HP, Paris, France.
Françoise
F
Hidden-Lucet
Cardiology Division, Rouen University Hospital, Rouen, France.
Frederic
F
Anselme
East Lyon School of Medicine, Louis Pradel Hospital, Bron, France.
Philippe
P
Chevalier
Cardiology Division, Rangueil University Hospital, Toulouse, France.
Philippe
P
Maury
Cardiology Division, Nancy University Hospital, Nancy, France.
Nicolas
N
Sadoul
Haut-Lévêque Hospital, Bordeaux, France.
Pierre
P
Bordachar
Saint Joseph Hospital, Paris, France.
Serge
S
Cazeau
Strasbourg University Hospital, Strasbourg, France.
Michel
M
Chauvin
Paris Cardiovascular Research Centre, Paris, France.
Jean-Philippe
JP
Empana
Cardiology Department, European Georges Pompidou Hospital, Paris, France Paris Descartes University, Paris, France Paris Cardiovascular Research Centre, Paris, France.
Xavier
X
Jouven
Pontchaillou University Hospital and INSERM 1099, CIC-IT 804 Rennes, France.
Jean-Claude
JC
Daubert
Cardiology Department, European Georges Pompidou Hospital, Paris, France Paris Descartes University, Paris, France Paris Cardiovascular Research Centre, Paris, France jean-yves.le-heuzey@egp.aphp.fr.
Jean-Yves
JY
Le Heuzey
D000368:Aged; D058406:Cardiac Resynchronization Therapy / Q000401:mortality*; D058409:Cardiac Resynchronization Therapy Devices; D016757:Death, Sudden, Cardiac / Q000453:epidemiology; D017147:Defibrillators, Implantable; D004812:Epidemiologic Methods; D005260:Female; D006333:Heart Failure / Q000401:mortality* / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis
Cardiac resynchronization; Cardioverter defibrillator; Competing risk; Heart failure; Sudden death