CRT and CABG Improve Survival and Reduce Readmissions in Ischemic Heart Failure: A Systematic Review and Meta-Analysis.
Tasneem Zanati Saeed, Ahmed Adel Mohamed, Mariam Hanna et al.
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In 30 seconds
This systematic review and meta-analysis assessed perioperative cardiac resynchronization therapy (CRT) added to coronary artery bypass grafting (CABG) in patients with ischemic cardiomyopathy and electromechanical dyssynchrony. Three studies included 300 patients; pooled analyses of two studies (n = 200) found CRT plus CABG was associated with lower heart-failure readmission (RR = 0.25, 95% CI [0.13-0.49], P < 0.0001) and all-cause mortality (RR = 0.44, 95% CI [0.25-0.78], p = 0.0048) than CABG alone. The authors characterize these findings as hypothesis-generating.
Key findings
- In two studies (n = 200), CRT plus CABG was associated with lower HF readmission: RR = 0.25, 95% CI [0.13-0.49], P < 0.0001.
- All-cause mortality was lower with CRT plus CABG: RR = 0.44, 95% CI [0.25-0.78], p = 0.0048.
- Analyses by study design found consistent effects across randomized and observational evidence, with no significant subgroup differences.
Why it matters
Heart-failure readmission and mortality are important outcomes for patients with ischemic cardiomyopathy undergoing CABG. The pooled findings suggest that adding CRT during surgery may improve both outcomes in patients with electromechanical dyssynchrony, but the small evidence base means the estimates should be interpreted cautiously rather than as definitive evidence.
What to keep in mind
Only three studies involving 300 patients were included, and the pooled outcome analyses covered two studies (n = 200). The authors describe the findings as hypothesis-generating and call for large-scale confirmatory randomized trials.