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著者: Inder S Anand, Peter Carson, Elizabeth Galle, Rui Song, John Boehmer, Jalal K Ghali, Brian Jaski, JoAnn Lindenfeld, Christopher O'Connor, Jonathan S Steinberg, Jill Leigh, Patrick Yong, Michael R Kosorok, Arthur M Feldman, David DeMets, Michael R Bristow
雑誌名: Circulation. 2009 Feb 24;119(7):969-77. doi: 10.1161/CIRCULATIONAHA.108.793273. Epub 2009 Feb 9.
Abstract/Text
BACKGROUND: In the Comparison of Medical Therapy, Pacing and Defibrillation in Heart Failure (COMPANION) trial, 1520 patients with advanced heart failure were assigned in a 1:2:2 ratio to optimal pharmacological therapy or optimal pharmacological therapy plus cardiac resynchronization therapy (CRT-P) or CRT with defibrillator (CRT-D). Use of CRT-P and CRT-D was associated with a significant reduction in combined risk of death or all-cause hospitalizations. Because mortality also was significantly reduced (optimal pharmacological therapy versus CRT-D only), an assessment of the true reduction in hospitalization rates must consider the competing risk of death and varying follow-up times.
METHODS AND RESULTS: To overcome the challenges of comparing treatment groups, we used a nonparametric test of right-censored recurrent events that accounts for multiple hospital admissions, differential follow-up time between treatment groups, and death as a competing risk. An end-point committee adjudicated and classified all hospitalizations. Compared with optimal pharmacological therapy, CRT-P and CRT-D were associated with a 21% and 25% reduction in all-cause, 34% and 37% reduction in cardiac, and 44% and 41% reduction in heart failure hospital admissions per patient-year of follow-up, respectively. Similar reductions were seen in hospitalization days per patient-year. The reduction in hospitalization rate for heart failure in the CRT groups appeared within days of randomization and remained sustained. Noncardiac hospitalization rates were not different between groups.
CONCLUSIONS: Use of CRT with or without a defibrillator in advanced heart failure patients was associated with marked reductions in all-cause, cardiac, and heart failure hospitalization rates in an analysis that accounted for the competing risk of mortality and unequal follow-up time.
PMID 19204305 Circulation. 2009 Feb 24;119(7):969-77. doi: 10.1161/CIRCULATIONAHA.108.793273. Epub 2009 Feb 9.
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