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Cardiac-resynchronization therapy for the prevention of heart-failure events.

Publication ,  Journal Article
Moss, AJ; Hall, WJ; Cannom, DS; Klein, H; Brown, MW; Daubert, JP; Estes, NAM; Foster, E; Greenberg, H; Higgins, SL; Pfeffer, MA; Solomon, SD ...
Published in: N Engl J Med
October 1, 2009

BACKGROUND: This trial was designed to determine whether cardiac-resynchronization therapy (CRT) with biventricular pacing would reduce the risk of death or heart-failure events in patients with mild cardiac symptoms, a reduced ejection fraction, and a wide QRS complex. METHODS: During a 4.5-year period, we enrolled and followed 1820 patients with ischemic or nonischemic cardiomyopathy, an ejection fraction of 30% or less, a QRS duration of 130 msec or more, and New York Heart Association class I or II symptoms. Patients were randomly assigned in a 3:2 ratio to receive CRT plus an implantable cardioverter-defibrillator (ICD) (1089 patients) or an ICD alone (731 patients). The primary end point was death from any cause or a nonfatal heart-failure event (whichever came first). Heart-failure events were diagnosed by physicians who were aware of the treatment assignments, but they were adjudicated by a committee that was unaware of assignments. RESULTS: During an average follow-up of 2.4 years, the primary end point occurred in 187 of 1089 patients in the CRT-ICD group (17.2%) and 185 of 731 patients in the ICD-only group (25.3%) (hazard ratio in the CRT-ICD group, 0.66; 95% confidence interval [CI], 0.52 to 0.84; P=0.001). The benefit did not differ significantly between patients with ischemic cardiomyopathy and those with nonischemic cardiomyopathy. The superiority of CRT was driven by a 41% reduction in the risk of heart-failure events, a finding that was evident primarily in a prespecified subgroup of patients with a QRS duration of 150 msec or more. CRT was associated with a significant reduction in left ventricular volumes and improvement in the ejection fraction. There was no significant difference between the two groups in the overall risk of death, with a 3% annual mortality rate in each treatment group. Serious adverse events were infrequent in the two groups. CONCLUSIONS: CRT combined with ICD decreased the risk of heart-failure events in relatively asymptomatic patients with a low ejection fraction and wide QRS complex. (ClinicalTrials.gov number, NCT00180271.)

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Published In

N Engl J Med

DOI

EISSN

1533-4406

Publication Date

October 1, 2009

Volume

361

Issue

14

Start / End Page

1329 / 1338

Location

United States

Related Subject Headings

  • Stroke Volume
  • Pacemaker, Artificial
  • Middle Aged
  • Male
  • Kaplan-Meier Estimate
  • Humans
  • Heart Failure
  • General & Internal Medicine
  • Female
  • Electric Countershock
 

Citation

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Moss, A. J., Hall, W. J., Cannom, D. S., Klein, H., Brown, M. W., Daubert, J. P., … MADIT-CRT Trial Investigators. (2009). Cardiac-resynchronization therapy for the prevention of heart-failure events. N Engl J Med, 361(14), 1329–1338. https://doi.org/10.1056/NEJMoa0906431
Moss, Arthur J., W Jackson Hall, David S. Cannom, Helmut Klein, Mary W. Brown, James P. Daubert, NA Mark Estes, et al. “Cardiac-resynchronization therapy for the prevention of heart-failure events.N Engl J Med 361, no. 14 (October 1, 2009): 1329–38. https://doi.org/10.1056/NEJMoa0906431.
Moss AJ, Hall WJ, Cannom DS, Klein H, Brown MW, Daubert JP, et al. Cardiac-resynchronization therapy for the prevention of heart-failure events. N Engl J Med. 2009 Oct 1;361(14):1329–38.
Moss, Arthur J., et al. “Cardiac-resynchronization therapy for the prevention of heart-failure events.N Engl J Med, vol. 361, no. 14, Oct. 2009, pp. 1329–38. Pubmed, doi:10.1056/NEJMoa0906431.
Moss AJ, Hall WJ, Cannom DS, Klein H, Brown MW, Daubert JP, Estes NAM, Foster E, Greenberg H, Higgins SL, Pfeffer MA, Solomon SD, Wilber D, Zareba W, MADIT-CRT Trial Investigators. Cardiac-resynchronization therapy for the prevention of heart-failure events. N Engl J Med. 2009 Oct 1;361(14):1329–1338.

Published In

N Engl J Med

DOI

EISSN

1533-4406

Publication Date

October 1, 2009

Volume

361

Issue

14

Start / End Page

1329 / 1338

Location

United States

Related Subject Headings

  • Stroke Volume
  • Pacemaker, Artificial
  • Middle Aged
  • Male
  • Kaplan-Meier Estimate
  • Humans
  • Heart Failure
  • General & Internal Medicine
  • Female
  • Electric Countershock