TY - JOUR
T1 - Syncope Predicts the Outcome of Cardiomyopathy Patients. Analysis of the SCD-HeFT Study
AU - Olshansky, Brian
AU - Poole, Jeanne E.
AU - Johnson, George
AU - Anderson, Jill
AU - Hellkamp, Anne S.
AU - Packer, Douglas
AU - Mark, Daniel B.
AU - Lee, Kerry L.
AU - Bardy, Gust H.
N1 - Funding Information:
Dr. Olshansky is a consultant, an investigator, on the Speaker’s Bureau, and has participated in scientific studies for Medtronic; is a consultant, an advisor, an investigator, on the Speaker’s Bureau, and has participated in scientific studies for Boston Scientific and Guidant; is a consultant and advisor for CV Therapeutics; is an advisor for BioControl; is on the Speakers’ Bureau for Reliant/Baxter; and is a consultant for Blackwell. Dr. Poole is on the Speakers’ Bureau of Medtronic, Guidant, and St. Jude Medical. Dr. Packer is a consultant, an investigator, on the Speakers’ Bureau, and has participated in scientific studies for Medtronic; is an investigator for and has participated in scientific studies for Biosense Webster, Boston Scientific, and Endocardial Solutions; is a consultant, an investigator, on the Speakers’ Bureau, and has participated in scientific studies for Cryocath; is an investigator, on the Speakers’ Bureau, and has participated in scientific studies for Guidant; is a consultant for Cryocor; and is on the Speakers’ Bureau for Berlex. Dr. Mark is a consultant, an investigator, and has participated in scientific studies for Medtronic. Dr. Lee is a consultant/advisor and has participated in scientific studies for Medtronic. Dr. Bardy has received research grants from Medtronic and the National Institutes of Health; is on the Board and has equity and intellectual property in Cameron Health; and has done consulting for Philips.
PY - 2008/4/1
Y1 - 2008/4/1
N2 - Objectives: The outcome of congestive heart failure (CHF) patients with syncope is understood incompletely. Background: We analyzed data from patients enrolled in the SCD-HeFT (Sudden Cardiac Death Heart Failure Trial) to determine whether syncope predicted outcomes in patients with CHF. Methods: We compared outcomes (and associated clinical characteristics) in patients with and without syncope enrolled in SCD-HeFT. Results: In SCD-HeFT, 162 (6%) patients had syncope before randomization, 356 (14%) had syncope after randomization (similar incidence in each randomized arm), and 46 (2%) had syncope before and after randomization. A QRS duration ≥120 ms and absence of beta-blocker use predicted syncope during follow-up (hazard ratio [HR] 1.30 and 95% confidence interval [CI] 1.06 to 1.61, p = 0.014 and HR 1.25, 95% CI 1.01 to 1.56, p = 0.048, respectively). Syncope recurrence did not differ by randomization arm. However, in the implantable cardioverter-defibrillator (ICD) arm, syncope, before and after randomization, was associated with appropriate ICD discharges (HR 1.75, 95% CI 1.10 to 2.80, p = 0.019 and HR 2.91, 95% CI 1.89 to 4.47, p = 0.001, respectively). Post-randomization syncope predicted total and cardiovascular death (HR 1.41, 95% CI 1.13 to 1.76, p = 0.002 and HR 1.55, 95% CI 1.19 to 2.02, p = 0.001, respectively). The elevated relative risk of mortality for syncope versus nonsyncope patients did not vary significantly across treatment arms (ICD, HR 1.54, 95% CI 1.04 to 2.27; amiodarone, HR 1.33, 95% CI 0.91 to 1.93; and placebo, HR 1.39, 95% CI 0.96 to 2.02, test for difference p = 0.86). Conclusions: For CHF patients with ICDs, syncope was associated with appropriate ICD activations. Syncope was associated with increased mortality risk in SCD-HeFT regardless of treatment arm (placebo, amiodarone, or ICD). (SCD-HeFT Trial; NCT00000609).
AB - Objectives: The outcome of congestive heart failure (CHF) patients with syncope is understood incompletely. Background: We analyzed data from patients enrolled in the SCD-HeFT (Sudden Cardiac Death Heart Failure Trial) to determine whether syncope predicted outcomes in patients with CHF. Methods: We compared outcomes (and associated clinical characteristics) in patients with and without syncope enrolled in SCD-HeFT. Results: In SCD-HeFT, 162 (6%) patients had syncope before randomization, 356 (14%) had syncope after randomization (similar incidence in each randomized arm), and 46 (2%) had syncope before and after randomization. A QRS duration ≥120 ms and absence of beta-blocker use predicted syncope during follow-up (hazard ratio [HR] 1.30 and 95% confidence interval [CI] 1.06 to 1.61, p = 0.014 and HR 1.25, 95% CI 1.01 to 1.56, p = 0.048, respectively). Syncope recurrence did not differ by randomization arm. However, in the implantable cardioverter-defibrillator (ICD) arm, syncope, before and after randomization, was associated with appropriate ICD discharges (HR 1.75, 95% CI 1.10 to 2.80, p = 0.019 and HR 2.91, 95% CI 1.89 to 4.47, p = 0.001, respectively). Post-randomization syncope predicted total and cardiovascular death (HR 1.41, 95% CI 1.13 to 1.76, p = 0.002 and HR 1.55, 95% CI 1.19 to 2.02, p = 0.001, respectively). The elevated relative risk of mortality for syncope versus nonsyncope patients did not vary significantly across treatment arms (ICD, HR 1.54, 95% CI 1.04 to 2.27; amiodarone, HR 1.33, 95% CI 0.91 to 1.93; and placebo, HR 1.39, 95% CI 0.96 to 2.02, test for difference p = 0.86). Conclusions: For CHF patients with ICDs, syncope was associated with appropriate ICD activations. Syncope was associated with increased mortality risk in SCD-HeFT regardless of treatment arm (placebo, amiodarone, or ICD). (SCD-HeFT Trial; NCT00000609).
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U2 - 10.1016/j.jacc.2007.11.065
DO - 10.1016/j.jacc.2007.11.065
M3 - Article
C2 - 18371559
AN - SCOPUS:40949088273
SN - 0735-1097
VL - 51
SP - 1277
EP - 1282
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 13
ER -