title: Long-term efficacy of implantable cardiac resynchronization therapy plus defibrillator for primary prevention of sudden cardiac death in patients with mild heart failure: an updated meta-analysis.
abstract: Previous studies of implantable cardiac resynchronization therapy plus defibrillator (CRT-D) therapy used for primary prevention of sudden cardiac death have suggested that CRT-D therapy is less effective in patients with mild heart failure and a wide QRS complex. However, the long-term benefits are variable. We performed a meta-analysis of randomized trials identified in systematic searches of MEDLINE, EMBASE, and the Cochrane Database. Three studies (3858 patients) with a mean follow-up of 66 months were included. Overall, CRT-D therapy was associated with significantly lower all-cause mortality than was implantable cardioverter defibrillator (ICD) therapy (OR, 0.78; 95 % CI, 0.63-0.96; P = 0.02; I (2) = 19 %). However, the risk of cardiac mortality was comparable between two groups (OR, 0.74; 95 % CI, 0.53-1.01; P = 0.06). CRT-D treatment was associated with a significantly lower risk of hospitalization for heart failure (OR, 0.67; 95 % CI, 0.50-0.89; P = 0.005; I (2) = 55 %). The composite outcome of all-cause mortality and hospitalization for heart failure was also markedly lower with CRT-D therapy than with ICD treatment alone (OR, 0.67; 95 % CI, 0.57-0.77; P < 0.0001; I (2) = 0 %). CRT-D therapy decreased the long-term risk of mortality and heart failure events in patients with mild heart failure with a wide QRS complex. However, long-term risk of cardiac mortality was similar between two groups. More randomized studies are needed to confirm these findings, especially in patients with NYHA class I heart failure or patients without LBBB.
authors.affiliation: Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China.|Beijing Luhe Hospital, Capital Medical University, Beijing, China.
authors.forename: Wei-Ping
authors.initials: WP
authors.lastname: Sun
authors.affiliation: Beijing Luhe Hospital, Capital Medical University, Beijing, China.
authors.forename: Chun-Lei
authors.initials: CL
authors.lastname: Li
authors.affiliation: Beijing Luhe Hospital, Capital Medical University, Beijing, China.
authors.forename: Jin-Cheng
authors.initials: JC
authors.lastname: Guo
authors.affiliation: Beijing Luhe Hospital, Capital Medical University, Beijing, China.
authors.forename: Li-Xin
authors.initials: LX
authors.lastname: Zhang
authors.affiliation: Beijing Luhe Hospital, Capital Medical University, Beijing, China.
authors.forename: Ran
authors.initials: R
authors.lastname: Liu
authors.affiliation: Beijing Luhe Hospital, Capital Medical University, Beijing, China. lhyyzhhbmd@126.com.
authors.forename: Hai-Bin
authors.initials: HB
authors.lastname: Zhang
authors.affiliation: Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China. zlilyepi@ccmu.edu.cn.|Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China. zlilyepi@ccmu.edu.cn.
authors.forename: Ling
authors.initials: L
authors.lastname: Zhang
mesh_terms: D001145:Arrhythmias, Cardiac / Q000628:therapy*; D058406:Cardiac Resynchronization Therapy; D058409:Cardiac Resynchronization Therapy Devices; D016757:Death, Sudden, Cardiac / Q000517:prevention & control*; D017147:Defibrillators, Implantable; D006333:Heart Failure / Q000401:mortality* / Q000628:therapy*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D011322:Primary Prevention; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: Cardiac resynchronization therapy; Cardiovascular events; Heart failure; Meta-analysis; Mortality