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Sex-Specific Mortality Risk by QRS Morphology and Duration in Patients Receiving CRT

Robbert Zusterzeel, MD,* Jeptha P. Curtis, MD,y Daniel A. Caños, MPH, PHD,* William E. Sanders, MD, MBA,* Kimberly A. Selzman, MD, MPH,* Ileana L. Piña, MD, MPH,* Erica S. Spatz, MD, MHS,y Haikun Bao, PHD,y Angelo Ponirakis, PHD,z Paul D. Varosy, MD,x Frederick A. Masoudi, MD, MSPH,{ David G. Strauss, MD, PHD*

BACKGROUND Prior studies have suggested that women have better outcomes than men after cardiac resynchronization
therapy-defibrillator (CRT-D) implantation.
OBJECTIVES The purpose of this study was to compare mortality after CRT-D implantation by sex, QRS morphology,
and duration.
METHODS Survival curves and covariate adjusted hazard ratios (HR) were used to assess mortality by sex in 31,892
CRT-D patients in the National Cardiovascular Data Registry (NCDR), implantable cardioverter defibrillator (ICD) registry
between 2006 and 2009, with up to 5 years’ follow-up (median 2.9 years, interquartile range: 2.0 to 3.9 years). Patients
were grouped by QRS morphology and 10-ms increments in QRS duration.
RESULTS Among patients with left bundle branch block (LBBB), women had a 21% lower mortality risk than men
(HR: 0.79; 95% CI: 0.74 to 0.84; p < 0.001); however, there was no sex difference in non-LBBB (HR: 0.95; 95% CI: 0.85
to 1.06; p ¼ 0.37). Longer QRS duration was associated with better survival in both sexes with LBBB, but not in patients
without LBBB. Compared with women with LBBB and QRS of 120 to 129 ms, women with LBBB and QRS of 140 to 149 ms
had a 27% lower mortality (HR: 0.73; 95% CI: 0.60 to 0.88; p ¼ 0.001); this difference was 18% in men (HR: 0.82; 95%
CI: 0.71 to 0.93; p ¼ 0.003). Mortality in LBBB and QRS of 150 ms or longer compared with those with LBBB and QRS of
120 to 129 ms was similar between sexes (HR: 0.61 to 0.68; p < 0.001 for women and HR: 0.58 to 0.66; p < 0.001 for
men). Sex interactions within 10-ms groups were not significant.
CONCLUSIONS Among patients with LBBB who received CRT-D, mortality is lower in women than men. Additionally,
longer QRS duration in LBBB is associated with better survival in both sexes. In contrast, there is no sex difference in
patients without LBBB, regardless of QRS duration. Further studies should include a non-CRT comparator group to
confirm these findings. (J Am Coll Cardiol 2014;64:887–94) © 2014 by the American College of Cardiology Foundation.

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