Key result
Implantable cardioverter-defibrillators reduced all-cause mortality by 44% (HR 0.56; 95% CI 0.32-1.01; P=0.053) compared to no ICD, provided they are implanted after a sufficient post-MI gap.
Why the study?
Sudden cardiac death accounts for nearly half of cardiovascular deaths, with AMI survivors at heightened risk primarily due to severe LV systolic dysfunction and arrhythmias.
Does an implantable cardioverter-defibrillator (ICD) reduce all-cause mortality and sudden cardiac death in post-myocardial infarction survivors?
Does an implantable cardioverter-defibrillator (ICD) reduce all-cause mortality and sudden cardiac death in post-myocardial infarction survivors?
Answers are grounded in this paper and cite their sources.
ICDs decrease all-cause and sudden cardiac death mortality in post-MI patients, but are primarily beneficial when implanted following a sufficient post-MI waiting period.
In the United States alone, sudden cardiac death (SCD) is responsible for nearly half of all the deaths associated with cardiovascular diseases. Acute myocardial infarction (AMI) survivors are at greater risk of SCD, mostly caused by severe left ventricular (LV) systolic dysfunction and cardiac arrhythmias. A device known as the automated implantable cardioverter-defibrillator (AICD) or implantable cardioverter-defibrillator (ICD) is implantable in the body, capable of delivering cardioversion, performing defibrillation, and (within some modern updates) pacing the heart. The all-cause mortality in patients with implanted ICD saw an adjusted reduction of 44% (HR 0.56, 95% CI: 0.32-1.01; P = 0.053)) in contrast to those with identical baseline. Subjects with implanted ICD three months following a myocardial infarction (MI) displayed insignificant greater mortality than those who did not implant an ICD. The factors favoring the implantation of ICD were, among many, elevated resting heart rate, multiple MIs, the occurrence of non-sustained ventricular tachycardia, syncope episodes, QRS duration of 120 milliseconds (ms), consumption of anti-arrhythmic medicine (often Class III), and MI index of longer than a year. The probability of obtaining an ICD depreciated as patients age. A notable predictor of death is extended periodic repolarization dynamics. To sum, cardioverter-defibrillators help decreases the mortality of all-cause and sudden cardiac death. It is noteworthy that ICDs are only meaningful if implanted following a sufficient post-MI period gap.
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Prima Hapsari Wulandari (2021) conducted a review in Post-myocardial infarction. Implantable Cardioverter-Defibrillator (ICD) vs. No ICD was evaluated on All-cause mortality (HR 0.56, 95% CI 0.32-1.01, p=0.053). Implantable cardioverter-defibrillators reduced all-cause mortality by 44% (HR 0.56; 95% CI 0.32-1.01; P=0.053) compared to no ICD, provided they are implanted after a sufficient post-MI gap.
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