PMID- 21282316
OWN - NLM
STAT- MEDLINE
DCOM- 20110602
LR  - 20211020
IS  - 1488-2329 (Electronic)
IS  - 0820-3946 (Print)
IS  - 0820-3946 (Linking)
VI  - 183
IP  - 4
DP  - 2011 Mar 8
TI  - Cardiac resynchronization therapy: a meta-analysis of randomized controlled 
      trials.
PG  - 421-9
LID - 10.1503/cmaj.101685 [doi]
AB  - BACKGROUND: Studies of cardiac resynchronization therapy in addition to an 
      implantable cardioverter defibrillator in patients with mild to moderate 
      congestive heart failure had not been shown to reduce mortality until the recent 
      RAFT trial (Resynchronization/Defibrillation for Ambulatory Heart Failure Trial). 
      We performed a meta-analysis including the RAFT trial to determine the effect of 
      cardiac resynchronization therapy with or without an implantable defibrillator on 
      mortality. METHODS: We searched electronic databases and other sources for 
      reports of randomized trials using a parallel or crossover design. We included 
      studies involving patients with heart failure receiving optimal medical therapy 
      that compared cardiac resynchronization therapy with optimal medical therapy 
      alone, or cardiac resynchronization therapy plus an implantable defibrillator 
      with a standard implantable defibrillator. The primary outcome was mortality. The 
      optimum information size was considered to assess the minimum amount of 
      information required in the literature to reach reliable conclusions about 
      cardiac resynchronization therapy. RESULTS: Of 3071 reports identified, 12 
      studies (n = 7538) were included in our meta-analysis. Compared with optimal 
      medical therapy alone, cardiac resynchronization therapy plus optimal medical 
      therapy significantly reduced mortality (relative risk [RR] 0.73, 95% confidence 
      interval [CI] 0.62-0.85). Compared with an implantable defibrillator alone, 
      cardiac resynchronization therapy plus an implantable defibrillator significantly 
      reduced mortality (RR 0.83, 95% CI 0.72-0.96). This last finding remained 
      significant among patients with New York Heart Association (NYHA) class I or II 
      disease (RR 0.80, 95% CI 0.67-0.96) but not among those with class III or IV 
      disease (RR 0.84, 95% CI 0.69-1.07). Analysis of the optimum information size 
      showed that the sequential monitoring boundary was crossed, which suggests no 
      need for further clinical trials. INTERPRETATION: The cumulative evidence is now 
      conclusive that the addition of cardiac resynchronization to optimal medical 
      therapy or defibrillator therapy significantly reduces mortality among patients 
      with heart failure.
FAU - Wells, George
AU  - Wells G
AD  - University of Ottawa Heart Institute, Ottawa, Ont. gawells@ottawaheart.ca
FAU - Parkash, Ratika
AU  - Parkash R
FAU - Healey, Jeffrey S
AU  - Healey JS
FAU - Talajic, Mario
AU  - Talajic M
FAU - Arnold, J Malcolm
AU  - Arnold JM
FAU - Sullivan, Shannon
AU  - Sullivan S
FAU - Peterson, Joan
AU  - Peterson J
FAU - Yetisir, Elizabeth
AU  - Yetisir E
FAU - Theoret-Patrick, Patricia
AU  - Theoret-Patrick P
FAU - Luce, Marilynn
AU  - Luce M
FAU - Tang, Anthony S L
AU  - Tang AS
LA  - eng
GR  - Canadian Institutes of Health Research/Canada
PT  - Journal Article
PT  - Meta-Analysis
PT  - Research Support, Non-U.S. Gov't
DEP - 20110131
PL  - Canada
TA  - CMAJ
JT  - CMAJ : Canadian Medical Association journal = journal de l'Association medicale 
      canadienne
JID - 9711805
SB  - IM
CIN - Evid Based Med. 2012 Apr;17(2):42-3. PMID: 21742668
CIN - CMAJ. 2011 Sep 20;183(13):1517-8; discussion 1519. PMID: 21930749
MH  - *Cardiac Pacing, Artificial
MH  - *Defibrillators, Implantable
MH  - Heart Failure/*mortality/*therapy
MH  - Humans
MH  - *Randomized Controlled Trials as Topic
PMC - PMC3050946
EDAT- 2011/02/02 06:00
MHDA- 2011/06/03 06:00
PMCR- 2011/03/08
CRDT- 2011/02/02 06:00
PHST- 2011/02/02 06:00 [entrez]
PHST- 2011/02/02 06:00 [pubmed]
PHST- 2011/06/03 06:00 [medline]
PHST- 2011/03/08 00:00 [pmc-release]
AID - cmaj.101685 [pii]
AID - 1830421 [pii]
AID - 10.1503/cmaj.101685 [doi]
PST - ppublish
SO  - CMAJ. 2011 Mar 8;183(4):421-9. doi: 10.1503/cmaj.101685. Epub 2011 Jan 31.