COMPANION

Comparison of Medical Therapy, Pacing, and Defibrillation in Heart Failure

Paciente / Población Intervención / Exposición Comparación Desenlace

In 1,520 patients with NYHA III-IV heart failure and QRS ≥ 120 ms, cardiac resynchronisation therapy (with or without a defibrillator) reduced all-cause death or hospitalisation compared with optimal medical therapy alone.

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Diseño

Randomised (1:2:2) three-arm trial

Desenlace

Composite of death from or hospitalisation for any cause

Relevancia

Resultadovs optimal medical therapy, CRT-P reduced the primary endpoint (HR 0.81; P=0.014) and CRT-D reduced it (HR 0.80; P=0.01); CRT-D also cut all-cause mortality (HR 0.64; P=0.003).

Bristow MR, et al. N Engl J Med. 2004;350(21):2140-2150. 10.1056/NEJMoa032423

Discusión y crítica

Only CRT-D reached significance for mortality (CRT-P borderline), and 1:2:2 allocation left the medical arm smaller. First trial to show CRT reduces morbidity/mortality in advanced HF, launching device-based therapy for wide-QRS HFrEF.