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Author Notes:
Correspondence: Mikhael Fariz El-Chami, MD, Medical office Tower, 550 Peachtree St, NE Atlanta, GA 30308, USA. Email: melcham@emory.edu. Telephone: 404-686-2504. Fax:404-686-4826.
Dr. El-Chami MF is a consultant for Boston Scientific and has received an institutional research grant from Medtronic.
Subjects:
Keywords:
- Octogenarians
- Cardiac resynchronization therapy
- Implantable cardioverter-defibrillator
Intermediate-term mortality and incidence of ICD therapy in octogenarians after cardiac resynchronization therapy
Abstract:
Background: Clinical outcomes of cardiac resynchronization therapy (CRT) in patients over the age of 80 have not been well described.
Methods: We retrospectively identified 96 consecutive patients ≥ 80 years old who underwent an initial implant or an upgrade to CRT, with or without defibrillator (CRT-D vs. CRT-P), at our institution between January 2003 and July 2008. The control cohort consisted of 177 randomly selected patients < 80 years old undergoing CRT implant during the same time period. The primary efficacy endpoint was all-cause mortality at 36 months, assessed by Kaplan-Meier time to first event curves.
Results: In the octogenarian cohort, mean age at CRT implant was 83.1 ± 2.9 years vs. 60.1 ± 8.8 years among controls (P < 0.001). Across both groups, 70% were male, mean left ventricular ejection fraction (LVEF) was 24.8% ± 14.1% and QRS duration was 154 ± 24.8 ms, without significant differences between groups. Octogenarians were more likely to have ischemic cardiomyopathy (74% vs. 37%, P < 0.001) and more likely to undergo upgrade to CRT instead of an initial implant (42% vs. 19%, P < 0.001). The rate of appropriate defibrillator shocks was lower among octogenarians (14% vs. 27%, P = 0.02) whereas the rate of inappropriate shocks was similar (3% vs. 6%, P = 0.55). At 36 months, there was no significant difference in the rate of all-cause mortality between octogenarians (11%) and controls (8%, P = 0.381).
Conclusion: Appropriately selected octogenarians who are candidates for CRT have similar intermediate-term mortality compared to younger patients receiving CRT.
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