Companion trial

Despite almost two decades of primary prevention ICD therapy being offered to patients with nonischemic cardiomyopathy, there remains some uncertainty about the magnitude of benefit in these patients, especially those who are also the recipients of the CRT. Most notably, the DANISH trial failed to demonstrate statistically significant improvement in all-cause mortality in patients with nonischemic cardiomyopathy undergoing ICD implantation. The startling lack of all-cause mortality reduction of CRT-D versus CRT-P in patients with ischemic cardiomyopathy appears to be related to older age and greater number of vascular comorbidities as well as noncardiac deaths in this cohort.

CRT-D vs. Study Questions: Do patients with heart failure with reduced ejection fraction due to nonischemic etiology eligible for cardiac resynchronization therapy CRT benefit from an implantable cardioverter-defibrillator ICD?

Bristow MR, et al. N Engl J Med ; Principal Findings: The trial was planned to include 2, patients; however, the Data Safety and Monitoring Board discontinued the trial early after the enrollment of 1, patients, due to superior efficacy of the primary endpoint in the CRT and CRT-D arms. Interpretation: Among patients with advanced CHF, treatment with CRT or CRT-D was associated with a reduction in the composite of all-cause mortality or all-cause hospitalizations at a median follow-up of 14 months.

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