Adding implantable cardioverter-defibrillator to cardiac re-synchronization therapy in patients with non-ischemic card-iomyopathy:a systematic review and meta-analysis with focus on elderly subpopulation
Vanda Devesa Neto1
Gonçalo Costa2
Luís Ferreira Santos3
Rogério Teixeira4
1.Unidade Local de Saúde Viseu Dão-Lafões,Coimbra,Portugal;Faculty of Health Sciences,University of Beira In-terior,Covilhã,Portugal2.Unidade Local de Saúde de Coimbra,Coimbra,Portugal;Faculdade de Medicina da Uni-versidade de Coimbra,Coimbra,Portugal3.Unidade Local de Saúde Viseu Dão-Lafões,Coimbra,Portugal4.Unidade Local de Saúde de Coimbra,Coimbra,Portugal;Faculdade de Medicina da Uni-versidade de Coimbra,Coimbra,Portugal;Coimbra Institute for Clinical and Biomedical Research(iCBR),Coimbra,Portugal
摘要：BACKGROUND Cardiac resynchronization therapy(CRT)has been a major therapeutic advancement for patients with heart failure and electrical dyssynchrony.While CRT improves symptoms,reduces hospitalizations,and enhances survival,the role of implantable cardioverter-defibrillators(ICDs)alongside CRT in patients with non-ischemic cardiomyopathy(NICM)remains controversial.To evaluate and compare the outcomes of CRT with ICD(CRT-D)versus CRT with pacemaker-only(CRT-P)in in-dividuals diagnosed with NICM,with a specific focus on the elderly.
METHODS A comprehensive search of PubMed,Embase,and the Cochrane Central Register of Controlled Trials was conduc-ted in January 2024.Studies comparing CRT-D and CRT-P in patients with NICM were included,with subgroup analyses focus-ing on patients aged 75 years and older.
RESULTS Twelve studies,including two randomized clinical trials,with a total of 62,145 patients and 16,754 pooled death events(9,171 in CRT-D and 7,583 in CRT-P),were analyzed.CRT-D was associated with a significantly lower risk of all-cause mortality compared to CRT-P(pooled OR=0.72;95％CI:0.61-0.85;P＜0.01),with significant heterogeneity(I2=83％).RCT sub-group analysis,was not statistically significant(pooled OR=0.82;95％CI:0.64-1.06;P=0.41;I2=0％).In patients older than 75 years,no significant difference in mortality risk was observed(pooled OR 0.96;95％CI:0.81-1.15;I2=39％).
CONCLUSION Our meta-analysis suggests that the addition of ICD therapy to CRT in patients with NICM significantly re-duces all-cause mortality.However,this benefit does not extend to cardiovascular mortality,likely due to the primary role of ICDs in preventing sudden cardiac death rather than other causes such as progressive heart failure.The survival advantage of CRT-D is most pronounced in younger patients,with those over 75 years of age deriving less benefit.This highlights the import-ance of careful patient selection,considering age and comorbidities,when deciding on ICD implantation in NICM patients.
机标关键词：meta-analysissynchronizationreviewfocuswithaddingcard-iomyopathycardiac
论文发表日期：2025-09-30
在线出版日期：2025-11-14（本平台首次上网日期，不代表文献的发表时间）
页数：9( 775-783 )