Cardiac Resynchronization Therapy Reduces the Risk of Hospitalizations in Patients With Advanced Heart Failure Results From the Comparison of Medical Therapy, Pacing and Defibrillation in Heart Failure (COMPANION) Trial
Cardiac Resynchronization Therapy Reduces the Risk of Hospitalizations in Patients With Advanced Heart Failure Results From the Comparison of Medical Therapy, Pacing and Defibrillation in Heart Failure (COMPANION) Trial
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DOI：
10.1161/circulationaha.108.793273
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发表时间：
2009-02-24
期刊：
影响因子：
37.8
通讯作者：
Bristow, Michael R.
中科院分区：
文献类型：
--
作者：
Anand, Inder S.;Carson, Peter;Bristow, Michael R.
背景-在心力衰竭药物治疗、起搏和除颤的比较（COMPANION）试验中，1520例晚期心力衰竭患者按1：2：2的比例被分配至最佳药物治疗或最佳药物治疗加心脏除颤治疗（CRT-P）或CRT+除颤器（CRT-D）。CRT-P和CRT-D的使用与死亡或全因住院的综合风险显著降低相关。因为死亡率也显著降低了方法和结果-为了克服比较治疗组的挑战，我们使用了右删失复发事件的非参数检验，该检验解释了多次住院，治疗组之间的不同随访时间，以及死亡作为竞争风险。终点委员会裁定并分类所有住院治疗。与最佳药物治疗相比，CRT-P和CRT-D每患者-年随访的全因住院率分别降低21%和25%，心脏病住院率分别降低34%和37%，心力衰竭住院率分别降低44%和41%。每患者年的住院天数也有类似的减少。CRT组中心力衰竭住院率的降低出现在随机化的几天内，并保持持续。非心脏病住院率并没有不同groups.Conclusion-Use的CRT与或不带除颤器的晚期心力衰竭患者与显着降低全因，心脏，心力衰竭住院率在一项分析，占死亡率和不平等的后续时间的竞争风险。（循环。2009; 119：969-977）。
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.Conclusion-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. (Circulation. 2009; 119: 969-977.)