Post-AMI recovery over 1 month resulted in 55% of patients with initial LVEF ≤40% improving their LVEF to >35%, with minimal further improvement (1.9 percentage units) over the next 2 months.
Cohort (n=100)
Does left ventricular ejection fraction improve sufficiently within 1 month after acute myocardial infarction to remove the indication for an implantable cardioverter-defibrillator?
The majority of LVEF improvement after AMI occurs within the first month, suggesting that waiting beyond this period for ICD implantation may not be necessary and leaves patients exposed to a high risk of life-threatening arrhythmias.
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 be established. Thus, the aim of this study was to investigate what proportion of post-AMI patients had improved LV function to such an extent that the indication for implantable cardioverter-defibrillator was no longer present. METHODS AND RESULTS: Patients admitted for AMI with reduced LVEF (≤40%) were eligible for inclusion. Repeat echocardiographic examinations were performed 5 days, 1 month, and 3 months after the AMI. We prospectively included 100 patients with LVEF of 31±5.8% after AMI. At the 1-month follow-up, 55% had an LVEF >35%. The main improvement in LVEF had occurred by 1 month. The mean difference in LVEF over the next 2 months was small, 1.9 percentage units. During the first 9 weeks, 10% of the patients suffered from life-threatening arrhythmias. CONCLUSIONS: Most patients have improved LVEF after AMI, and in the majority, the improvement can be confirmed after 1 month, implying that further delay of implantable cardioverter-defibrillator implantation may not be warranted. Life-threatening arrhythmias occurred in 10% of the patients, illustrating the high risk for sudden cardiac death in this population.
Sjöblom et al. (Wed,) conducted a cohort in Acute Myocardial Infarction with reduced LVEF (n=100). Echocardiographic follow-up was evaluated on Proportion of patients with LVEF >35%. Post-AMI recovery over 1 month resulted in 55% of patients with initial LVEF ≤40% improving their LVEF to >35%, with minimal further improvement (1.9 percentage units) over the next 2 months.