title: Cardiac resynchronization therapy combined with coronary artery bypass grafting in ischaemic heart failure patients: long-term results of the RESCUE study.
abstract: OBJECTIVE
  Totally epicardial cardiac resynchronization therapy (CRT) is a novel treatment modality for patients with heart failure (HF) and systolic dyssynchrony undergoing coronary artery bypass grafting (CABG). In this study, we have prospectively evaluated the long-term outcomes of totally epicardial CRT.
  
  
  METHODS
  Between September 2007 and June 2009, one hundred and seventy-eight patients were randomly assigned to the CABG alone group (n = 87) and CABG with concomitant epicardial CRT implantation (n = 91). The primary end-point of the study was all-cause mortality in the two groups between the day of surgery and 13 August 2013 (common closing date). The secondary outcomes included mode of death, adverse cardiac events and lead performance.
  
  
  RESULTS
  The mean follow-up was 55 ± 10.7 months. According to per-protocol analysis with treatment as a time-dependent variable to account for conversion from CABG to CABG + CRT, there were 24 deaths (35.8%) in the CABG group and 17 deaths (15.3%) in the CABG + CRT group. When compared with CABG alone, concomitant CRT was associated with reduced risk of both all-cause mortality [hazard ratio (HR) 0.43, 95% confidence interval (CI) 0.23-0.84, P = 0.012] and cardiac death (HR 0.39, 95% CI 0.21-0.72, P = 0.002). Eleven (12.6%) sudden deaths were observed in the CABG group in comparison with 4 (4.4%) in the CABG + CRT group (P = 0.048). Hospital readmission was required for 9 (9.9%) patients in CABG + CRT group and for 25 (28.7%) patients in the CABG group (P = 0.001). There were 4 (1.5%) epicardial lead failures.
  
  
  CONCLUSIONS
  The results of our study suggest that the procedure of CABG and totally epicardial CRT system implantation is safe and significantly improves the survival of patients with HF and dyssynchrony during long-term follow-up.
  
  
  BACKGROUND
  NCT 00846001 (http://www.clinicaltrials.gov).
authors.affiliation: State Research Institute of Circulation Pathology, Novosibirsk, Russian Federation abromanov@mail.ru aromanov1981@rambler.ru.
authors.forename: Alexander
authors.initials: A
authors.lastname: Romanov
authors.affiliation: Medical University of Silesia, Katowice, Poland.
authors.forename: Kinga
authors.initials: K
authors.lastname: Goscinska-Bis
authors.affiliation: Medical University of Silesia, Katowice, Poland.
authors.forename: Jaroslaw
authors.initials: J
authors.lastname: Bis
authors.affiliation: State Research Institute of Circulation Pathology, Novosibirsk, Russian Federation.
authors.forename: Alexander
authors.initials: A
authors.lastname: Chernyavskiy
authors.affiliation: State Research Institute of Circulation Pathology, Novosibirsk, Russian Federation.
authors.forename: Darya
authors.initials: D
authors.lastname: Prokhorova
authors.affiliation: State Research Institute of Circulation Pathology, Novosibirsk, Russian Federation.
authors.forename: Yana
authors.initials: Y
authors.lastname: Syrtseva
authors.affiliation: State Research Institute of Circulation Pathology, Novosibirsk, Russian Federation.
authors.forename: Vitaliy
authors.initials: V
authors.lastname: Shabanov
authors.affiliation: State Research Institute of Circulation Pathology, Novosibirsk, Russian Federation.
authors.forename: Sergey
authors.initials: S
authors.lastname: Alsov
authors.affiliation: State Research Institute of Circulation Pathology, Novosibirsk, Russian Federation.
authors.forename: Alexander
authors.initials: A
authors.lastname: Karaskov
authors.affiliation: Medical University of Silesia, Katowice, Poland.
authors.forename: Marek
authors.initials: M
authors.lastname: Deja
authors.affiliation: Medical University of Silesia, Katowice, Poland.
authors.forename: Michal
authors.initials: M
authors.lastname: Krejca
authors.affiliation: State Research Institute of Circulation Pathology, Novosibirsk, Russian Federation.
authors.forename: Evgeny
authors.initials: E
authors.lastname: Pokushalov
mesh_terms: D058406:Cardiac Resynchronization Therapy / Q000379:methods* / Q000401:mortality; D003131:Combined Modality Therapy; D001026:Coronary Artery Bypass / Q000379:methods* / Q000401:mortality; D016757:Death, Sudden, Cardiac / Q000209:etiology; D004868:Equipment Failure; D005260:Female; D006333:Heart Failure / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D012737:Sex Factors; D013318:Stroke Volume / Q000502:physiology; D016896:Treatment Outcome
keywords: Coronary artery bypass grafting; Dyssynchrony; Epicardial lead; Ischaemic heart failure; Resynchronization therapy