Prophylactic use of an implantable cardioverter-defibrillator after acute myocardial infarction.
نویسندگان
چکیده
BACKGROUND Implantable cardioverter-defibrillator (ICD) therapy has been shown to improve survival in patients with various heart conditions who are at high risk for ventricular arrhythmias. Whether benefit occurs in patients early after myocardial infarction is unknown. METHODS We conducted the Defibrillator in Acute Myocardial Infarction Trial, a randomized, open-label comparison of ICD therapy (in 332 patients) and no ICD therapy (in 342 patients) 6 to 40 days after a myocardial infarction. We enrolled patients who had reduced left ventricular function (left ventricular ejection fraction, 0.35 or less) and impaired cardiac autonomic function (manifested as depressed heart-rate variability or an elevated average 24-hour heart rate on Holter monitoring). The primary outcome was mortality from any cause. Death from arrhythmia was a predefined secondary outcome. RESULTS During a mean (+/-SD) follow-up period of 30+/-13 months, there was no difference in overall mortality between the two treatment groups: of the 120 patients who died, 62 were in the ICD group and 58 in the control group (hazard ratio for death in the ICD group, 1.08; 95 percent confidence interval, 0.76 to 1.55; P=0.66). There were 12 deaths due to arrhythmia in the ICD group, as compared with 29 in the control group (hazard ratio in the ICD group, 0.42; 95 percent confidence interval, 0.22 to 0.83; P=0.009). In contrast, there were 50 deaths from nonarrhythmic causes in the ICD group and 29 in the control group (hazard ratio in the ICD group, 1.75; 95 percent confidence interval, 1.11 to 2.76; P=0.02). CONCLUSIONS Prophylactic ICD therapy does not reduce overall mortality in high-risk patients who have recently had a myocardial infarction. Although ICD therapy was associated with a reduction in the rate of death due to arrhythmia, that was offset by an increase in the rate of death from nonarrhythmic causes.
منابع مشابه
Evolution of Left Ventricular Ejection Fraction After Acute Myocardial Infarction: Implications for Implantable Defibrillator Eligibility Running title: Sjöblom et al.; ICD early after myocardial infarction
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متن کاملEvolution of Left Ventricular Ejection Fraction After Acute Myocardial Infarction: Implications for Implantable Defibrillator Eligibility
Background—ICD therapy improves survival in patients with reduced left ventricular ejection
متن کاملArrhythmia Risk Stratification after Myocardial Infarction
Summary Post-myocardial infarction ventricular arrhythmia and sudden cardiac death risk remain important issues in these patients. In high-risk post-myocardial infarction (MI) patients prophylactic implantable cardioverter defibrillators (ICD) may significantly improve survival. Risk stratification studies of post-MI patients will allow ICD therapy to be applied in a more cost-effective manner....
متن کاملEvolution of left ventricular ejection fraction after acute myocardial infarction: implications for implantable cardioverter-defibrillator eligibility.
BACKGROUND Implantable cardioverter-defibrillator therapy improves survival in patients with reduced left ventricular ejection fraction (LVEF) after acute myocardial infarction (AMI). Although the risk of sudden cardiac death is highest in the first month after AMI, there is no survival benefit of early implantable cardioverter-defibrillator implantation, and the optimal time frame has yet to b...
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عنوان ژورنال:
- The New England journal of medicine
دوره 351 24 شماره
صفحات -
تاریخ انتشار 2004