Key result
Early ICDs show no mortality benefit in post-STEMI patients with impaired LVEF and inducible VT.
Why the study?
Methods to identify high-risk patients and the optimal timing of ICD therapy after ST-elevation myocardial infarction require further optimization.
Does early risk stratification with EPS and targeted ICD implantation reduce total mortality in patients with STEMI treated with primary PCI?
Population
Consecutive patients treated with primary PCI for acute STEMI (group 1 n=574, group 2 n=83, group 3 n=32)
Comparison
LVEF >40% vs LVEF <=40% without inducible VT vs LVEF <=40% with inducible sustained monomorphic VT and ICD
Design
Cohort study
Follow-up
Median 12 months
Authors
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Early ICD was not linked to lower mortality in this cohort; leaves open whether RCTs are needed to guide post-STEMI decisions.
Cohort (n=689)
Does early risk stratification with EPS and targeted ICD implantation reduce total mortality in patients with STEMI treated with primary PCI?
Absolute Event Rate: 6% vs 3%
p-value: p=0.879
Early risk stratification using EPS to guide targeted ICD implantation in STEMI patients with LVEF ≤40% achieves low mortality rates comparable to patients with preserved LVEF.
Zaman et al. (2009) conducted a cohort in acute ST-elevation myocardial infarction (n=689). Early ICD implantation for inducible ventricular tachycardia vs. No ICD was evaluated on total mortality (p=0.879). Early ICD implantation for post-STEMI patients with impaired LVEF and inducible ventricular tachycardia yielded a 6% mortality rate, similar to patients without ICDs (3%; P=0.879).
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