TY - JOUR
T1 - Sex-specific mortality risk by QRS morphology and duration in patients receiving CRT
T2 - Results from the NCDR
AU - Zusterzeel, Robbert
AU - Curtis, Jeptha P.
AU - Caños, Daniel A.
AU - Sanders, William E.
AU - Selzman, Kimberly A.
AU - Piña, Ileana L.
AU - Spatz, Erica S.
AU - Bao, Haikun
AU - Ponirakis, Angelo
AU - Varosy, Paul D.
AU - Masoudi, Frederick A.
AU - Strauss, David G.
N1 - Funding Information:
This project was conducted under contract between the American College of Cardiology (ACC) and the U.S. Food and Drug Administration (FDA) and was supported by the FDA Office of Women’s Health and by a research fellowship from the Oak Ridge Institute for Science and Education through an interagency agreement between the U.S. Department of Energy and the FDA. The ICD Registry is an initiative of the American College of Cardiology Foundation with partnering support from the Heart Rhythm Society . Dr. Masoudi is the Senior Medical Officer and Chair of the Science and Quality Oversight Committee of the National Cardiovascular Data Registry (NCDR). Dr. Curtis has received research and salary support under contract with the ACC NCDR. Dr. Curtis holds equity interest in Medtronic, a maker of cardiac devices. Dr. Piña has received consulting fees/honoraria from Novartis and GE Healthcare. The mention of commercial products, their sources, or their use in connection with material reported herein is not to be construed as either an actual or implied endorsement of such products by the Department of Health and Human Services. The views expressed in this manuscript represent those of the authors, and do not necessarily represent the official views of the NCDR or its associated professional societies identified at www.ncdr.com . All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
PY - 2014/9/2
Y1 - 2014/9/2
N2 - Background Prior studies have suggested that women have better outcomes than men after cardiac resynchronization therapy-defibrillator (CRT-D) implantation. Objectives The purpose of this study was to compare mortality after CRT-D implantation by sex, QRS morphology, and duration. Methods Survival curves and covariate adjusted hazard ratios (HR) were used to assess mortality by sex in 31,892 CRT-D patients in the National Cardiovascular Data Registry (NCDR), implantable cardioverter defibrillator (ICD) registry between 2006 and 2009, with up to 5 years' follow-up (median 2.9 years, interquartile range: 2.0 to 3.9 years). Patients were grouped by QRS morphology and 10-ms increments in QRS duration. Results Among patients with left bundle branch block (LBBB), women had a 21% lower mortality risk than men (HR: 0.79; 95% CI: 0.74 to 0.84; p < 0.001); however, there was no sex difference in non-LBBB (HR: 0.95; 95% CI: 0.85 to 1.06; p = 0.37). Longer QRS duration was associated with better survival in both sexes with LBBB, but not in patients without LBBB. Compared with women with LBBB and QRS of 120 to 129 ms, women with LBBB and QRS of 140 to 149 ms had a 27% lower mortality (HR: 0.73; 95% CI: 0.60 to 0.88; p = 0.001); this difference was 18% in men (HR: 0.82; 95% CI: 0.71 to 0.93; p = 0.003). Mortality in LBBB and QRS of 150 ms or longer compared with those with LBBB and QRS of 120 to 129 ms was similar between sexes (HR: 0.61 to 0.68; p < 0.001 for women and HR: 0.58 to 0.66; p < 0.001 for men). Sex interactions within 10-ms groups were not significant. Conclusions Among patients with LBBB who received CRT-D, mortality is lower in women than men. Additionally, longer QRS duration in LBBB is associated with better survival in both sexes. In contrast, there is no sex difference in patients without LBBB, regardless of QRS duration. Further studies should include a non-CRT comparator group to confirm these findings.
AB - Background Prior studies have suggested that women have better outcomes than men after cardiac resynchronization therapy-defibrillator (CRT-D) implantation. Objectives The purpose of this study was to compare mortality after CRT-D implantation by sex, QRS morphology, and duration. Methods Survival curves and covariate adjusted hazard ratios (HR) were used to assess mortality by sex in 31,892 CRT-D patients in the National Cardiovascular Data Registry (NCDR), implantable cardioverter defibrillator (ICD) registry between 2006 and 2009, with up to 5 years' follow-up (median 2.9 years, interquartile range: 2.0 to 3.9 years). Patients were grouped by QRS morphology and 10-ms increments in QRS duration. Results Among patients with left bundle branch block (LBBB), women had a 21% lower mortality risk than men (HR: 0.79; 95% CI: 0.74 to 0.84; p < 0.001); however, there was no sex difference in non-LBBB (HR: 0.95; 95% CI: 0.85 to 1.06; p = 0.37). Longer QRS duration was associated with better survival in both sexes with LBBB, but not in patients without LBBB. Compared with women with LBBB and QRS of 120 to 129 ms, women with LBBB and QRS of 140 to 149 ms had a 27% lower mortality (HR: 0.73; 95% CI: 0.60 to 0.88; p = 0.001); this difference was 18% in men (HR: 0.82; 95% CI: 0.71 to 0.93; p = 0.003). Mortality in LBBB and QRS of 150 ms or longer compared with those with LBBB and QRS of 120 to 129 ms was similar between sexes (HR: 0.61 to 0.68; p < 0.001 for women and HR: 0.58 to 0.66; p < 0.001 for men). Sex interactions within 10-ms groups were not significant. Conclusions Among patients with LBBB who received CRT-D, mortality is lower in women than men. Additionally, longer QRS duration in LBBB is associated with better survival in both sexes. In contrast, there is no sex difference in patients without LBBB, regardless of QRS duration. Further studies should include a non-CRT comparator group to confirm these findings.
KW - QRS duration
KW - QRS morphology
KW - cardiac resynchronization therapy
KW - men
KW - women
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U2 - 10.1016/j.jacc.2014.06.1162
DO - 10.1016/j.jacc.2014.06.1162
M3 - Article
C2 - 25169173
AN - SCOPUS:84907373620
VL - 64
SP - 887
EP - 894
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
SN - 0735-1097
IS - 9
ER -