Effects of cardiac resynchronization therapy with pacemaker and cardiac resynchronization therapy with defibrillator on the outcomes of patients with heart failure: a meta - analysis / 中华急诊医学杂志

ABSTRACT

Objective To evaluate the effects of cardiac resynchronization therapy with pacemaker (CRT- P) and cardiac resynchronization therapy with defibrillator (CRT -D) on the outcomes of patients with heart failure.Methods MEDLINE,Cochrane Controlled Trials Register,EMBASE and Chinese Wan Fang,CNKI database were searched to collect data from randomized controlled trials and cohort trials of CRT - P versus CRT - D for the treatment of heart failure from January 1,1990 through September 30,2011.Meta - analysis of data including all causes leading to mortality and mortality of sudden cardiac arrest and heart failure was carried out by using the RevMan 5.0 package.Results A total of 3 404 patients were collected from seven studies.Pooled analysis demonstrated CRT - D significantly reduced mortalities of all causes in comparison with CRT - P [ odds ratio (OR) =0.61,95％ confidence interval (CI) =0.47 ～0.79,P =0.0001 ].Sub - group analysis showed that an increased benefit was seen after extended follow -up period ( after 1 year,OR =0.56,95 ％ CI =0.41 ～ 0.77,P =0.0004),but not after relatively short follow - up period ( within one year,OR =0.76,95 ％ CI =0.54 ～ 1.06,P =0.11 ).Mortalities of sudden cardiac arrest ( OR =0.20,95％ CI =0.07 ～ 0.59,P =0.003) and heart failure ( OR =0.72,95％ CI =0.54 ～ 0.96,P =0.02) of patients treated with CRT - D were lower than those of patients treated with CRT- P.Conclusions This study suggests that CRT - D is superior over CRT - P in respect of better outcome of patients with heart failure.