Key result
Treatment of acute myocardial infarction according to the standardized MISSION! protocol resulted in only 6% of patients meeting criteria for prophylactic ICD implantation within 1 year.
Why the study?
Does a standardized, aggressive treatment protocol for AMI reduce the proportion of patients meeting criteria for prophylactic ICD implantation?
Cohort (n=676)
Does a standardized, aggressive treatment protocol for AMI reduce the proportion of patients meeting criteria for prophylactic ICD implantation?
Implementation of a standardized, aggressive treatment protocol for AMI results in a low rate (6%) of patients requiring prophylactic ICD implantation, with excellent long-term prevention of sudden cardiac death.
Few AMI patients meet modern ICD criteria; leaves open optimal selection for primary prevention.
AIMS: To assess the number of patients in daily clinical practice that meets criteria for implantation of an implantable cardioverter defibrillator (ICD) following acute myocardial infarction (AMI) when treated according to an aggressive treatment protocol. METHODS AND RESULTS: Patients were treated according to the MISSION! protocol. The protocol encompasses pre-hospital, in-hospital, and outpatient clinical framework for the acute and chronic treatment of AMI patients and the decision making regarding primary prevention of sudden cardiac death (SCD). A total of 676 consecutive AMI patients (78% male, mean age 59 +/- 12 years) treated according to the MISSION! protocol were included in this analysis. Left ventricular ejection fraction at 3 months was 54 +/- 10%. Only 39 (6%) patients met criteria for implantation of an ICD <1 year post-MI. These patients suffered more extensive infarctions as indicated by higher peak troponin T values (mean 14.5 +/- 8.3 vs. 6.5 +/- 14.7 microg/L; P < 0.001) and had more left anterior descending artery related infarctions (79 vs. 46%; P < 0.001). Cumulative first appropriate therapy rate was 15% at 3 years follow-up. No SCD was observed in the study population. CONCLUSION: Aggressive treatment of AMI patients and close monitoring after the index event according to a standardized protocol, results in only a small number of patients becoming candidate for prophylactic ICD implantation. An easy-to-use protocol combining aggressive reperfusion, optimal medication, and a risk stratification algorithm tailored to fit within routine practice may help to maintain ICD implantation rates within manageable proportions.
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Atary et al. (2010) conducted a cohort in acute myocardial infarction (n=676). MISSION! protocol was evaluated on Meeting criteria for implantation of an implantable cardioverter defibrillator (ICD) <1 year post-MI. Treatment of acute myocardial infarction according to the standardized MISSION! protocol resulted in only 6% of patients meeting criteria for prophylactic ICD implantation within 1 year.
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