Correspondence
use was consistent with guideline National and Kapodistrian University of Athens, membrane oxygenation (VA-ECMO)
School of Medicine, Attikon University Hospital,
recommendations that were applicable group or the control group, nor did it
Athens 124 61, Greece (GF); Medical University of
during the enrolment period. South Carolina, Charleston, SC, USA (MRG); study the effects of the reperfusion time
Komamura and Iwase raise an Department of Cardiology, Ziekenhuis Oost- on all-cause death rate 30 days after
imp ort ant question regarding Limburg, Genk, Belgium (WM); Hasselt University, in-hospital randomisation.1 Therefore,
Hasselt, Belgium (WM); National Cerebral and
how investigators determined the Cardiovascular Center, Osaka, Japan (KK); King Saud we suggest that this IPD meta-analysis
position of the left ventricular lead University, Faculty of Medicine, Riyadh, Saudi Arabia should be supplemented with subgroup
for an effective CRT response. The (ASH); University of Ottawa Heart Institute, Ottawa, analyses based on long and short
ON, Canada (DB); Medtronic Bakken Research
study protocol recommended left Center, Maastricht, Netherlands (BG); University of reperfusion times.
ventricular lead placement in a Rennes, Rennes, France (CL) Second, one of the subgroup analyses
lateral, anterolateral, or posterolateral 1 Wilkoff BL, Filippatos G, Leclercq C, et al. was done according to thrombolysis
position; but implantation and place Adaptive versus conventional cardiac in myocardial infarction (TIMI) flow
resynchronisation therapy in patients with
ment optimisation were performed at heart failure (AdaptResponse): a global, grade after percutaneous coronary
physician discretion. A large majority prospective, randomised controlled trial. intervention. The two subgroups were
Lancet 2023; 402: 1147–57.
of AdaptResponse participants receiv TIMI flow 0 or 1 and TIMI flow 2 or 3.1 A
2 Yancy CW, Jessup M, Bozkurt B, et al. 2013
ed a quadripolar left ventricular lead ACCF/AHA guideline for the management of study by Vdovin and colleagues showed
and methods used to optimise left heart failure: a report of the American College that patients with a final TIMI flow of
of Cardiology Foundation/American Heart
ventri c ular lead placement were Association Task Force on Practice Guidelines. 3 had a lower cumulative mortality than
captured in the study (data not Circulation 2013; 128: e240–327. those with a final TIMI flow of less than
published). Notably, 3350 (92·6%) 3 Ponikowski P, Voors AA, Anker SD, et al. 2016 3.4 A study by Sohail and colleagues
ESC Guidelines for the diagnosis and treatment
of 3617 study participants had an of acute and chronic heart failure: the task force also showed that higher mortality is
improved or unchanged clinical for the diagnosis and treatment of acute and significantly correlated with not having
chronic heart failure of the European Society of
composite score indicating a high CRT Cardiology (ESC) developed with the special a TIMI flow of 3.5 Therefore, we suggest
response rate (table 2 of the original contribution of the Heart Failure Association that the IPD meta-analysis should
(HFA) of the ESC. Eur Heart J 2016; 37: 2129–200.
Article1). The low overall event rates 4 McMurray JJ, Packer M, Desai AS, et al.
adjust the subgroups to TIMI flow less
and high CRT response rate observed Angiotensin-neprilysin inhibition versus than or equal to 2 and TIMI flow of 3.
in both study arms suggest that enalapril in heart failure. N Engl J Med 2014;
We declare no competing interests.
371: 993–1004.
the left ventricular leads were in an 5 Friedman DJ, Al-Khatib SM, Dalgaard F, et al. Guizhong Wang, Jianbin Guan,
effective position. CRT improves outcomes in patients with IVCD
*Zhanguo Liu
but not RBBB: a patient-level meta-analysis of
The AdaptResponse study was funded by Medtronic. randomized controlled trials. Circulation 2023; [email protected]
GF reports receiving lecture fees from Bayer, 147: 812–23.
Department of Critical Care Medicine, Zhujiang
Boehringer Ingelheim, Servier, and Novartis; 6 Cleland JG, Abraham WT, Linde C, et al.
Hospital, Southern Medical University, Guangzhou
participating in committees of trials sponsored by An individual patient meta-analysis of five
randomized trials assessing the effects of 510280, China (GW, JG, ZL)
Novo Nordisc, Bayer, Boehringer Ingelheim, Servier,
Vifor, Cardior, Impulse Dynamics, and Medtronic; cardiac resynchronization therapy on morbidity 1 Zeymer U, Freund A, Hochadel M, et al.
and receiving research grants from the EU. CL and mortality in patients with symptomatic Venoarterial extracorporeal membrane
heart failure. Eur Heart J 2013; 34: 3547–56. oxygenation in patients with infarct-related
reports participating in a Medtronic advisory board
and receiving honoraria from Medtronic, Biotronik, cardiogenic shock: an individual patient data
meta-analysis of randomised trials. Lancet
LivaNova, Boston Scientific, and Abbott. MRG
reports being a consultant for Medtronic and Boston VA-ECMO for infarct- 2
2023; 402: 1338–46.
Brodie BR, Stuckey TD, Muncy DB, et al.
Scientific and receiving honoraria from Medtronic,
Boston Scientific, and EBR Systems. KK reports related cardiogenic Importance of time-to-reperfusion in patients
with acute myocardial infarction with and
receiving speaker’s honoraria and research grants
from Medtronic Japan and Biotronik Japan; and shock without cardiogenic shock treated with
primary percutaneous coronary intervention.
having received grants from Boston Scientific Japan. Am Heart J 2003; 145: 708–15.
BG reports being an employee and is a minority 3 Kochan A, Lee T, Moghaddam N, et al.
shareholder of Medtronic. DB reports receiving
It is an honour to read the publication of Reperfusion delays and outcomes among
research funding from Medtronic and Boston the individual patient data (IPD) meta- patients with ST-segment-elevation myocardial
Scientific, Boehringer Ingelheim, Bayer, Biotronik, analysis by Uwe Zeymer and colleagues.1 infarction with and without cardiogenic shock.
Pfizer, and Bristol Myers Squibb. All other authors Circ Cardiovasc Interv 2023; 16: e012810.
declare no competing interests. The authors would
However, it seems to have two issues. 4 Vdovin N, Günther SPW, de Waha S, et al. Early
like to acknowledge their colleague and the first First, studies by Brodie and colleagues2 risk stratification in patients with cardiogenic
shock complicating acute myocardial infarction
author of the original Article, Dr Bruce L Wilkoff, who and Kochan and colleagues 3 have treated with extracorporeal life support and
passed away on Jan 7, 2024.
shown that reperfusion time is critical primary percutaneous coronary intervention.
*Gerasimos Filippatos, Michael R Gold, for the survival of patients with infarct- JACC Cardiovasc Interv 2017; 10: 2469–71.
5 Sohail S, Fan E, Foroutan F, Ross HJ, Billia F,
Wilfried Mullens, Kengo Kusano, related cardiogenic shock. However, Alba AC. Predictors of mortality in patients
Ahmad S Hersi, David Birnie, Zeymer and colleagues’ IPD meta- treated with veno-arterial ECMO for cardiogenic
Bart Gerritse, Christophe Leclercq analysis did not show the reperfusion shock complicating acute myocardial infarction:
a systematic review and meta-analysis.
[email protected] times of the venoarterial extracorporeal J Cardiovasc Transl Res 2022; 15: 227–38.
www.thelancet.com Vol 403 June 8, 2024 2485
