Key result
Early ICD implantation after myocardial infarction failed to reduce total mortality, as decreased sudden cardiac death was offset by increased nonsudden deaths.
Why the study?
Does early implantable cardioverter-defibrillator implantation reduce total mortality in patients following myocardial infarction?
Does early implantable cardioverter-defibrillator implantation reduce total mortality in patients following myocardial infarction?
Early ICD implantation after myocardial infarction does not reduce total mortality due to an offsetting increase in non-sudden cardiac deaths, supporting current guidelines to wait at least 40 days.
Supports deferring ICD ≥40 days post-MI; confirms offsetting nonsudden mortality limits early benefit.
The implantable cardioverter-defibrillator (ICD), when implanted in the late phase of myocardial infarction (MI) in the primary prevention of sudden cardiac death, reduces total mortality by 23-31%. Current guidelines recommend ICD implantation at least 40 days after MI. Despite optimal MI therapy, the risk of sudden cardiac death or cardiac arrest remains highest within the first 30 days after index infarction. Two randomized trials with ICD implantation early after MI failed to show the reduction of total mortality in a long-term follow-up study. The decrease of sudden cardiac death incidence was counterbalanced by an increase of nonsudden deaths, which may have been caused by the augmentation of heart failure deaths in ICD groups, presumably due to ICD interventions. Therefore, optimizing ICD appears to be the most important issue influencing the long-term outcome.
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Średniawa et al. (2010) conducted a review in Myocardial Infarction. Implantable cardioverter-defibrillator (ICD) was evaluated on Total mortality. Early ICD implantation after myocardial infarction failed to reduce total mortality, as decreased sudden cardiac death was offset by increased nonsudden deaths.
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