Az orvos-, egészségtudományi- és gyógyszerészképzés tudományos műhelyeinek fejlesztése(EFOP-3.6.3-VEKOP-16-2017-00009)
Támogató: EFOP-VEKOP
(TKP2021-NVA-12) Támogató: Innovációs és Technológiai Minisztérium
Szakterületek:
Klinikai orvostan
and aim: This study aimed to investigate the treatment effect of Cardiac Resynchronization
Therapy with Defibrillator (CRT-D) on mortality compared to CRT-Pacemaker (CRT-P)
and identify subgroups. Moreover, to assess the time-trend on treatment effect and
the characteristics of patients while the indications have changed in the last decades.PubMed,
CENTRAL and Embase up to October 2021 were screened for studies comparing CRT-P and
CRT-D, focusing on mortality. Altogether 26 observational studies were selected comprising
128,030 CRT patients, including 55,469 with CRT-P, and 72,561 with CRT-D device.CRT-D
was able to reduce all-cause mortality by almost 20% over CRT-P (aHR:0.85; 95%CI:0.76-0.94;
p<0.01) even in propensity-matched studies (HR:0.83; 95%CI:0.80-0.87; p<0.001), but
not in those with non-ischemic etiology (HR 0.95, 95%CI:0.79-1.15; p=0.19) or over
75 years (HR 1.08, 95%CI 0.96-1.21; p=0.17). When treatment effect on mortality was
investigated by the median year of inclusion, there was a difference between studies
released before 2015 and those thereafter. Time-trend effects could be also observed
in patients' characteristics: CRT-P candidates were getting older and the prevalence
of ischemic etiology were increasing over time.Conclusion: The results of this systematic
review of observational studies, mostly retrospective with meta-analysis, suggest
that patients with CRT-D had a lower risk of mortality compared to CRT-P. However,
subgroups could be identified, where CRT-D was not superior such as non-ischemic and
older patients. An improved treatment effect of CRT-D on mortality could be observed
between the early and late studies partly related to the changed characteristics of
CRT candidates.
