CeRtiTuDe Cohort: CRT-P or CRT-D?
Most patients with a cardiac resynchronisation therapy (CRT) pacemaker (CRT-P) would not benefit from the addition of a defibrillator, according to results from the CeRtiTuDe Cohort study presented Sept. 1 at ESC Congress 2015 in London and simultaneously published in European Heart Journal.
The CeRtiTuDe study evaluated 1,705 patients implanted with a CRT (CRT-P: 535; cardiac resynchronisation therapy defibrillator (CRT-D): 1,170) in France between 2008 and 2010. Adjudication for causes of death was conducted at two-years follow up. Overall findings showed that patients with CRT-P compared to CRT-D were older (75.9 vs. 65.6 years) and more often female (80.8 percent) than male (69.5 percent). In addition, CRT-P patients were more symptomatic, with less coronary artery disease, more atrial fibrillation and more comorbidities.
Investigators noted that at the end of two years, 267 patients had died, giving an annual overall mortality rate of 83.8 per 1,000. The crude mortality rate among CRT-P patients was double compared to CRT-D. "By cause-of-death analysis, 95 percent of the excess mortality among CRT-P subjects was related to an increase of non-sudden death," said Professor Jean-Yves Le Heuzey, MD, at Georges Pompidou Hospital, René Descartes University in Paris, France. "This could indicate that this excess mortality is due to heart failure and non-cardiovascular events."
According to Le Heuzey, the study's findings suggest that patients selected for CRT-P in routine clinical practice would not benefit from the addition of a defibrillator. "This indicates that CRT-D rates could be reduced, with consequent decreases in costs and device-related complications," he said.
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