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Time-dependent benefit of preventive cardiac resynchronization therapy after myocardial infarction

Aims Cardiac remodelling is a progressive process after myocardial infarction (MI). However, currently there are no data regarding the effect of elapsed time from MI on the benefit of cardiac resynchronization therapy with defibrillator (CRT-D). The present study was designed to evaluate the relatio...

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Bibliographic Details
Published in:European heart journal 2011-07, Vol.32 (13), p.1614-1621
Main Authors: Barsheshet, Alon, Moss, Arthur J., Eldar, Michael, Huang, David T., Hall, W. Jackson, Klein, Helmut U., McNitt, Scott, Steinberg, Jonathan S., Wilber, David J., Zareba, Wojciech, Goldenberg, Ilan
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Language:English
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Summary:Aims Cardiac remodelling is a progressive process after myocardial infarction (MI). However, currently there are no data regarding the effect of elapsed time from MI on the benefit of cardiac resynchronization therapy with defibrillator (CRT-D). The present study was designed to evaluate the relationship between elapsed time from MI and the benefit of preventive CRT-D therapy in patients with ischaemic cardiomyopathy (ICM). Methods and results The risk of heart failure (HF) or death as a function of elapsed time from MI to enrolment, by treatment with CRT-D vs. implantable cardioverter defibrillator (ICD)-only therapy, was assessed among 704 ICM patients with a documented MI enrolled in MADIT-CRT, and separately in a subset of ICM patients without a documented prior MI (n = 237). In ICD patients, the adjusted risk of HF or death increased by 4% (P = 0.01) for each year elapsed from MI. Multivariate analysis demonstrated that patients with remote MI [categorized at the median value (≥8 years)] derived a significantly greater benefit from CRT-D [HR = 0.42 (P < 0.001)] than those with a more recent MI [HR = 1.26 (P = 0.35); P-value for interaction
ISSN:0195-668X
1522-9645
DOI:10.1093/eurheartj/ehq392