Renal function and the long-term clinical outcomes of cardiac resynchronization therapy with or without defibrillation.
Pacing Clin Electrophysiol
; 42(6): 595-602, 2019 06.
Article
em En
| MEDLINE
| ID: mdl-30873640
ABSTRACT
BACKGROUND AND AIMS:
Patients with moderate-to-severe chronic kidney disease (CKD) are underrepresented in clinical trials of cardiac resynchronization therapy (CRT)-defibrillation (CRT-D) or CRT-pacing (CRT-P). We sought to determine whether outcomes after CRT-D are better than after CRT-P over a wide spectrum of CKD. METHODS ANDRESULTS:
Clinical events were quantified in relation to preimplant estimated glomerular filtration rate (eGFR) after CRT-D (n = 410 [39.2%]) or CRT-P (n = 636 [60.8%]) implantation. Over a follow-up period of 3.7 years (median, interquartile range 2.1-5.7), the eGFR < 60 group (n = 598) had a higher risk of total mortality (adjusted hazard ratio [aHR] 1.28; P = 0.017), total mortality or heart failure (HF) hospitalization (aHR 1.32; P = 0.004), total mortality or hospitalization for major adverse cardiac events (MACEs, aHR 1.34; P = 0.002), and cardiac mortality (aHR 1.33; P = 0.036), compared to the eGFR ≥ 60 group (n = 448), after covariate adjustment. In analyses of CRT-D versus CRT-P, CRT-D was associated with a lower risk of total mortality (eGFR ≥ 60 HR 0.65; P = 0.028; eGFR < 60 HR 0.64, P = 0.002), total mortality or HF hospitalization (eGFR ≥ 60 aHR 0.66; P = 0.021; eGFR < 60 aHR 0.69, P = 0.007), total mortality or hospitalization for MACEs (eGFR ≥ 60 aHR 0.70; P = 0.039; eGFR < 60 aHR 0.69, P = 0.005), and cardiac mortality (eGFR ≥ 60 aHR 0.60; P = 0.026; eGFR < 60 aHR 0.55; P = 0.003).CONCLUSION:
In CRT recipients, moderate CKD is associated with a higher mortality and morbidity compared to normal renal function or mild CKD. Despite less favorable absolute outcomes, patients with moderate CKD had better outcomes after CRT-D than after CRT-P.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Doenças Cardiovasculares
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Terapia de Ressincronização Cardíaca
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Falência Renal Crônica
Limite:
Aged
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Female
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Humans
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Male
Idioma:
En
Ano de publicação:
2019
Tipo de documento:
Article