Comparative Effectiveness of CRT-D Versus Defibrillator Alone in HF Patients With Moderate-to-Severe Chronic Kidney Disease

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY

卷:66

Article

Friedman, Daniel J.¹  Singh, Jagmeet P.²  Curtis, Jeptha P.³  Tang, W. H. Wilson⁴  Bao, Haikun³  Spatz, Erica S.³  Hernandez, Adrian F.^1,5  Patel, Uptal D.^5,6  Al-Khatib, Sana M.^1,5 

[1] Duke Univ Hosp, Div Cardiol, Durham, NC USA

[2] Massachusetts Gen Hosp, Cardiac Arrhythmia Serv, Boston, MA 02114 USA

[3] Yale Univ, Sch Med, New Haven, CT USA

[4] Cleveland Clin, Dept Cardiovasc Med, Cleveland, OH 44106 USA

[5] Duke Clin Res Inst, Durham, NC 27715 USA

[6] Duke Univ Hosp, Div Nephrol, Durham, NC USA

关键词: biventricular;    cardiomyopathy;    chronic kidney disease;    pacemaker;   

DOI  :  10.1016/j.jacc.2015.09.097

来源: Elsevier

【 摘 要 】

BACKGROUND Patients with moderate-to-severe chronic kidney disease (CKD) are poorly represented in clinical trials of cardiac resynchronization therapy (CRT). OBJECTIVES This study sought to assess the real-world comparative effectiveness of CRT with defibrillator (CRT-D) versus implantable cardioverter-defibrillator (ICD) alone in CRT-eligible patients with moderate-to-severe CKD. METHODS We conducted an inverse probability-weighted analysis of 10,946 CRT-eligible patients (ejection fraction <35%, QRS >120 ms, New York Heart Association functional class III/IV) with stage 3 to 5 CKD in the National Cardiovascular Data Registry (NCDR) ICD Registry, comparing outcomes between patients who received CRT-D (n = 9,525) versus ICD only (n = 1,421). Outcomes were obtained via Medicare claims and censored at 3 years. The primary endpoint of heart failure (HF) hospitalization or death and the secondary endpoint of death were assessed with Cox proportional hazards models. HF hospitalization, device explant, and progression to end-stage renal disease were assessed using Fine-Gray models. RESULTS After risk adjustment, CRT-D use was associated with a reduction in HF hospitalization or death (hazard ratio [HR]: 0.84; 95% confidence interval [CI]: 0.78 to 0.91; p < 0.0001), death (HR: 0.85; 95% CI: 0.77 to 0.93; p < 0.0004), and HF hospitalization alone (subdistribution HR: 0.84; 95% CI: 0.76 to 0.93; p < 0.009). Subgroup analyses suggested that CRT was associated with a reduced risk of HF hospitalization and death across CKD classes. The incidence of in-hospital, short-term, and mid-term device-related complications did not vary across CKD stages. CONCLUSIONS In a nationally representative population of HF and CRT-eligible patients, use of CRT-D was associated with a significantly lower risk of the composite endpoint of HF hospitalization or death among patients with moderate-to-severe CKD in the setting of acceptable complication rates. (C) 2015 by the American College of Cardiology Foundation.

【 授权许可】

Free