Gender-Related Differences in Outcomes of Patients with Cardiac Resynchronization Therapy

作者：Nevzorov Roman^*; Porter Avital; Mostov Shanie; Kazum Shirit; Eisen Alon; Goldenberg Gustavo; Iakobishvili Zaza; Kusniec Jairo; Golovchiner Gregory; Stra**erg Boris; Haim Moti

来源：Israel Medical Association Journal, 2018, 20(5): 311-315.

• cardiac resynchronization therapy (CRT)
• gender differences
• chronic heart failure (CHF)
• implantable cardioverter defibrillator (ICD)

Background: Gender-related differences (GRD) exist in the outcome of patients with cardiac resynchronization therapy (CRT).
Objectives: To assess GRD in patients who underwent CRT.
Methods: A retrospective cohort of 178 patients who were implanted with a CRT in a tertiary center 2005-2009 was analyzed. Primary outcome was 1 year mortality. Secondary endpoints were readmission and complication rates.
Results: No statistically significant difference was found in 1 year mortality rates (14.6% males vs. 11.8% females, P = 0.7) or in readmission rate (50.7% vs. 41.2%, P = 0.3). The complication rate was only numerically higher in women (14.7% vs. 5.6%, P = 0.09). Men more often had CRT defibrillator (CRT-D) implants (63.2% vs. 35.3%, P = 0.003) and had a higher rate of ischemic cardiomyopathy (79.2% vs. 38.2%, P < 0.001). There was a trend to higher incidence of ventricular fibrillation/ventricular tachycardia in men before CRT implantation (29.9% vs. 14.7%, P = 0.07%). A higher proportion of men upgraded from implantable cardioverter defibrillator (ICD) to CRT-D, 20.8% vs. 8.8%, P = 0.047. On multivariate model, chronic renal failure was an independent predictor of 1 year mortality (hazard ratio [HR] 3.6; 95% confidence interval [95%Cl] 1.4-9.5), CRT-D had a protective effect compared to CRT-pacemaker (HR 0.3, 95%Cl 0.12-0.81).
Conclusions: No GRD was found in 1 year mortality or readmission rates in patients treated with CRT. There was a,trend toward a higher complication rate in females. Men were implanted more often with CRT-D and more frequently underwent upgrading of ICD to CRT-D.

• 出版日期2018-5