MADIT-CRT trial - Summary & Results

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A Multicenter Automatic Defibrillator Implantation Trial with Cardiac Resynchronization Therapy (MADIT-CRT) with patients in NYHA class 1 or 2 with LVEF and ventricular dyssynchrony.

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MADIT-CRT trial - Summary & Results

  1. 1. MADIT-CRT (Multicenter AutomaticDefibrillator Implantation Trial withCardiac Resynchronization Therapy)
  2. 2. MADIT-CRT (Multicenter Automatic DefibrillatorImplantation 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) eventsCRT-D=cardiac resynchronization therapy deviceICD=implantable cardioverter defibrillator
  3. 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 yearsHR (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=0.003b, p≤0.001 d. p=0.01
  4. 4. MADIT-CRT: Commentary*"The magnitude of the effect that we saw in this population is as big as what wehad seen in past years with beta blockers, as big as what we saw with ACEinhibitors." - Dr Angelo Auricchio"I think for those physicians who have not accepted CRT, its time." - Dr Clyde W Yancy"We have to understand which patients we should be doing this in, because its anexpensive therapy. . . . And we have to ask, is there a cheaper way to keep peopleout 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)
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