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

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