医学
四分位间距
心脏再同步化治疗
心力衰竭
射血分数
内科学
心脏病学
QRS波群
除颤
心脏移植
植入式心律转复除颤器
回廊的
作者
John L. Sapp,Soori Sivakumaran,Calum J. Redpath,Habib Khan,Ratika Parkash,Derek V. Exner,Jeff S. Healey,Bernard Thibault,Laurence D. Sterns,Nguyen Tung Lam,Jaimie Manlucu,Ahmed T. Mokhtar,Glen Sumner,Stuart McKinlay,Shane Kimber,Blandine Mondésert,Mario Talajic,Jean L. Rouleau,Catherine McCarron,George A. Wells,Anthony Tang
标识
DOI:10.1056/nejmoa2304542
摘要
BackgroundThe Resynchronization–Defibrillation for Ambulatory Heart Failure Trial (RAFT) showed a greater benefit with respect to mortality at 5 years among patients who received cardiac-resynchronization therapy (CRT) than among those who received implantable cardioverter–defibrillators (ICDs). However, the effect of CRT on long-term survival is not known.MethodsWe randomly assigned patients with New York Heart Association (NYHA) class II or III heart failure, a left ventricular ejection fraction of 30% or less, and an intrinsic QRS duration of 120 msec or more (or a paced QRS duration of 200 msec or more) to receive either an ICD alone or a CRT defibrillator (CRT-D). We assessed long-term outcomes among patients at the eight highest-enrolling participating sites. The primary outcome was death from any cause; the secondary outcome was a composite of death from any cause, heart transplantation, or implantation of a ventricular assist device.Download a PDF of the Research Summary.ResultsThe trial enrolled 1798 patients, of whom 1050 were included in the long-term survival trial; the median duration of follow-up for the 1050 patients was 7.7 years (interquartile range, 3.9 to 12.8), and the median duration of follow-up for those who survived was 13.9 years (interquartile range, 12.8 to 15.7). Death occurred in 405 of 530 patients (76.4%) assigned to the ICD group and in 370 of 520 patients (71.2%) assigned to the CRT-D group. The time until death appeared to be longer for those assigned to receive a CRT-D than for those assigned to receive an ICD (acceleration factor, 0.80; 95% confidence interval, 0.69 to 0.92; P=0.002). A secondary-outcome event occurred in 412 patients (77.7%) in the ICD group and in 392 (75.4%) in the CRT-D group.ConclusionsAmong patients with a reduced ejection fraction, a widened QRS complex, and NYHA class II or III heart failure, the survival benefit associated with receipt of a CRT-D as compared with ICD appeared to be sustained during a median of nearly 14 years of follow-up. (RAFT ClinicalTrials.gov number, NCT00251251.) Quick Take Resynchronization–Defibrillation for Heart Failure 2m 16s
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