Cited by 3,157Cardiac pacing and defibrillation studiesCardiac Arrest and ResuscitationCardiac Health and Mental Health

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Cardiac-Resynchronization Therapy for the Prevention of Heart-Failure Events

Moss, Arthur J., Hall, W. Jackson, Cannom, David S., Klein, Helmut, Brown, Mary W., Daubert, James P., Estes, N.A. Mark, Foster, Elyse, Greenberg, Henry, Higgins, Steven L., Pfeffer, Marc A., Solomon, Scott D., Wilber, David, Zareba, Wojciech·2009·New England Journal of Medicine

DOI 10.1056/nejmoa0906431

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Abstract

BACKGROUND: This trial was designed to determine whether cardiac-resynchronization therapy (CRT) with biventricular pacing would reduce the risk of death or heart-failure events in patients with mild cardiac symptoms, a reduced ejection fraction, and a wide QRS complex. METHODS: During a 4.5-year period, we enrolled and followed 1820 patients with ischemic or nonischemic cardiomyopathy, an ejection fraction of 30% or less, a QRS duration of 130 msec or more, and New York Heart Association class I or II symptoms. Patients were randomly assigned in a 3:2 ratio to receive CRT plus an implantable cardioverter-defibrillator (ICD) (1089 patients) or an ICD alone (731 patients). The primary end point was death from any cause or a nonfatal heart-failure event (whichever came first). Heart-failure events were diagnosed by physicians who were aware of the treatment assignments, but they were adjudicated by a committee that was unaware of assignments. RESULTS: During an average follow-up of 2.4 years, the primary end point occurred in 187 of 1089 patients in the CRT-ICD group (17.2%) and 185 of 731 patients in the ICD-only group (25.3%) (hazard ratio in the CRT-ICD group, 0.66; 95% confidence interval [CI], 0.52 to 0.84; P=0.001). The benefit did not differ significantly between patients with ischemic cardiomyopathy and those with nonischemic cardiomyopathy. The superiority of CRT was driven by a 41% reduction in the risk of heart-failure events, a finding that was evident primarily in a prespecified subgroup of patients with a QRS duration of 150 msec or more. CRT was associated with a significant reduction in left ventricular volumes and improvement in the ejection fraction. There was no significant difference between the two groups in the overall risk of death, with a 3% annual mortality rate in each treatment group. Serious adverse events were infrequent in the two groups. CONCLUSIONS: CRT combined with ICD decreased the risk of heart-failure events in relatively asymptomatic patients with a low ejection fraction and wide QRS complex. (ClinicalTrials.gov number, NCT00180271.)

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Authors: Moss, A. J., Hall, W. J., Cannom, D. S., Klein, H., Brown, M. W., Daubert, J. P., Estes, N. A. M., Foster, E., Greenberg, H., Higgins, S. L., Pfeffer, M. A., Solomon, S. D., Wilber, D., & Zareba, W.
Affiliations: University of Rochester Medicine (US)
Good Samaritan Hospital (US)
Duke Medical Center (US)
University of California, San Francisco (US)
St. Luke's-Roosevelt Hospital Center (US)
Scripps Memorial Hospital (US)
Brigham and Women's Hospital (US)
Loyola University Medical Center (US)
ORCID: Moss, Arthur J.
Hall, W. Jackson
Cannom, David S.
Klein, Helmut
Daubert, James P.
Greenberg, Henry
Pfeffer, Marc A.
Solomon, Scott D.
Wilber, David
Venue: New England Journal of Medicine
Publisher: Massachusetts Medical Society
Published: 2009-10
Volume: 361
Issue: 14
Pages: 1329-1338
ISSN: 0028-4793 (ISSN-L)
1533-4406
DOI: 10.1056/nejmoa0906431
OpenAlex: W2146521529
Cited by: 3,157
References: 17
Citations by year: 2026: 106 · 2025: 116 · 2024: 137 · 2023: 188 · 2022: 140 · 2021: 155 · 2020: 163 · 2019: 173 · 2018: 174 · 2017: 199 · 2016: 210 · 2015: 210 · 2014: 227 · 2013: 243 · 2012: 267
FWCI: 151.00
Type: journal article
Language: en
Open access: closed
Locations: New England Journal of Medicine (publishedVersion)
PubMed (publishedVersion)
Institutional Research Information System (Università degli Studi di Brescia) (submittedVersion)
Topics: Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac pacing and defibrillation studies
Health Sciences › Medicine › Emergency Medicine › Cardiac Arrest and Resuscitation
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
Keywords: cardiac resynchronization therapy, implantable cardioverter-defibrillator, heart failure prevention, reduced ejection fraction, wide QRS complex, ischemic cardiomyopathy, non-ischemic cardiomyopathy, left ventricular volume, ejection fraction, mortality, asymptomatic patients
MeSH terms: Aged, Cardiac Pacing, Artificial, Electric Countershock, Female, Heart Failure, Humans, Male, Middle Aged, Pacemaker, Artificial, Stroke Volume, Defibrillators, Implantable, Disease-Free Survival, Kaplan-Meier Estimate

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Cardiac-Resynchronization Therapy for the Prevention of Heart-Failure Events

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