Comparison of Medical Therapy, Pacing and Defibrillation in Heart Failure (COMPANION)

• Results
• Design
• Patient Population
• Clinical Relevance
• References

Results

• A Boston Scientific pacemaker with CRT capabilities (CRT-P), in combination with OPT, reduced the risk of all-cause mortality or first hospitalization by 19% when compared with OPT alone. (p value: 0.015)


• A defibrillator with CRT capabilities (CRT-D), in combination with OPT, reduced the risk of all-cause mortality or first hospitalization by 20% when compared with OPT alone. (p value: 0.011)


• CRT-D, in combination with OPT, reduced the risk of all-cause mortality by 36% when compared with OPT alone. (p value: 0.004)

Design

Randomization (1:2:2)
20% received OPT alone
40% received OPT + CRT-P
40% received OPT + CRT-D

Patient Population

1520 Heart Failure patients

• NYHA Class III/IV
• EF ≤ 35%
• QRS ≥ 120ms
• PR interval ≥ 150 ms

128 U.S. centers

Clinical Relevance

• The primary endpoint Combination of all-cause mortality or first hospitalization as measured by time to first event.
• Proved for the first time that CRT-D therapy, used in combination with OPT, can significantly improve both the quality and duration of life for patients with late-stage symptomatic heart failure versus using OPT alone.
• As a result of COMPANION, the benefits of CRT-D therapy are available to heart failure patients who otherwise do not have an ICD indication.

References

1 Bristow MR, Saxon LA, Boehmer J, et al. Cardiac resynchronization therapy with or without an implantable defibrillator in advanced chronic heart failure. N Engl J Med 2004:350:2140-2150.