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MADIT-CRT (Multicenter Automatic
Defibrillator Implantation Trial with
Cardiac Resynchronization Therapy)
MADIT-CRT (Multicenter Automatic Defibrillator
Implantation Trial with Cardiac Resynchronization Therapy)
AJ Moss (University of Rochester Medical Center, NY)
European Society of Cardiology 2009 Congress


• Population:
    1820 patients in NYHA class 1 or 2, with LVEF <30% and ventricular
    dyssynchrony—defined by an electrocardiographic QRS duration ≥130 ms
    Patients with ischemic cardiomyopathy could be in NYHA class 1 or 2 and
    those with nonischemic disease had to be in NYHA class 2
• Treatment:
    Randomized 3:2 to receive a CRT-D device or an ICD only
    Optimal medical therapy was required in both groups
• Primary outcome:
    Death from any cause or nonfatal heart failure (HF) events


CRT-D=cardiac resynchronization therapy device
ICD=implantable cardioverter defibrillator
MADIT-CRT: Results

• The addition of resynchronization pacing cut the risk of death or heart-failure
 events by about a third over two and a half years

HR (95%CI) for the primary end point and its components:
CRT-D patients (n=1089) vs ICD-only patients (n=731)a
 End point         All patients                Patients with ischemic   Patient with nonischemic
                                               cardiomyopathy           cardiomyopathy

 Death or HF       0.66 (0.52–0.84)b           0.67 (0.52–0.88)c        0.62 (0.44–0.89)d

 HF only           0.59 (0.47–0.74)b           0.58 (0.44–0.78)b        0.59 (0.41–0.87)d

 Death             1.00 (0.69–1.44)            1.06 (0.68–1.64)         0.87 (0.44–1.70)




a. At a median of 2.4 years       c. p=0.003
b, p≤0.001                        d. p=0.01
MADIT-CRT: Commentary*

"The magnitude of the effect that we saw in this population is as big as what we
had seen in past years with beta blockers, as big as what we saw with ACE
inhibitors."
                                                                - Dr Angelo Auricchio


"I think for those physicians who have not accepted CRT, it's time."

                                                                                             - Dr Clyde W Yancy


"We have to understand which patients we should be doing this in, because it's an
expensive therapy. . . . And we have to ask, is there a cheaper way to keep people
out of the hospital than doing [CRT]?"
                                                                 - Dr Mariell Jessup

 *All comments from MADIT-CRT: Resynchronization therapy cuts heart-failure risk in patients with only
 mild disease (http://www.theheart.org/article/997499.do)
Become a member of http://www.theheart.org
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MADIT-CRT trial - Summary & Results

  • 1. MADIT-CRT (Multicenter Automatic Defibrillator Implantation Trial with Cardiac Resynchronization Therapy)
  • 2. MADIT-CRT (Multicenter Automatic Defibrillator Implantation Trial with Cardiac Resynchronization Therapy) AJ Moss (University of Rochester Medical Center, NY) European Society of Cardiology 2009 Congress • Population: 1820 patients in NYHA class 1 or 2, with LVEF <30% and ventricular dyssynchrony—defined by an electrocardiographic QRS duration ≥130 ms Patients with ischemic cardiomyopathy could be in NYHA class 1 or 2 and those with nonischemic disease had to be in NYHA class 2 • Treatment: Randomized 3:2 to receive a CRT-D device or an ICD only Optimal medical therapy was required in both groups • Primary outcome: Death from any cause or nonfatal heart failure (HF) events CRT-D=cardiac resynchronization therapy device ICD=implantable cardioverter defibrillator
  • 3. MADIT-CRT: Results • The addition of resynchronization pacing cut the risk of death or heart-failure events by about a third over two and a half years HR (95%CI) for the primary end point and its components: CRT-D patients (n=1089) vs ICD-only patients (n=731)a End point All patients Patients with ischemic Patient with nonischemic cardiomyopathy cardiomyopathy Death or HF 0.66 (0.52–0.84)b 0.67 (0.52–0.88)c 0.62 (0.44–0.89)d HF only 0.59 (0.47–0.74)b 0.58 (0.44–0.78)b 0.59 (0.41–0.87)d Death 1.00 (0.69–1.44) 1.06 (0.68–1.64) 0.87 (0.44–1.70) a. At a median of 2.4 years c. p=0.003 b, p≤0.001 d. p=0.01
  • 4. MADIT-CRT: Commentary* "The magnitude of the effect that we saw in this population is as big as what we had seen in past years with beta blockers, as big as what we saw with ACE inhibitors." - Dr Angelo Auricchio "I think for those physicians who have not accepted CRT, it's time." - Dr Clyde W Yancy "We have to understand which patients we should be doing this in, because it's an expensive therapy. . . . And we have to ask, is there a cheaper way to keep people out of the hospital than doing [CRT]?" - Dr Mariell Jessup *All comments from MADIT-CRT: Resynchronization therapy cuts heart-failure risk in patients with only mild disease (http://www.theheart.org/article/997499.do)
  • 5. Become a member of http://www.theheart.org Become a fan on Facebook: http://www.facebook.com/theheartorg Follow us on Twitter: http://www.twitter.com/theheartorg theheart.org is the leading online source of independent cardiology news. We are the top provider of news and opinions for over 100 000 physicians.