Long-Term Outcome of the Randomized DAPA Trial
Key result
Prophylactic ICD implantation significantly reduced all-cause mortality compared to conventional medical therapy at 3 years (5% vs 13%; HR 0.37, 95% CI 0.15-0.95) in high-risk STEMI patients.
Why the study?
The study aimed to evaluate the survival benefit of prophylactic ICD implantation in early selected high-risk patients after primary PCI for STEMI.
Does prophylactic ICD implantation reduce all-cause mortality in high-risk patients after primary percutaneous coronary intervention for ST-segment-elevation myocardial infarction?
Population
266 high-risk patients after primary PCI for STEMI
Comparison
Prophylactic ICD implantation vs conventional medical therapy
Design
Randomized, multicenter, controlled trial
Follow-up
Median 9 years
Authors
Discussion
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Member takes
Implication
Supports prophylactic ICD 30-60 days post-primary PCI in high-risk STEMI; extends prior mortality benefit to contemporary reperfusion era.
Study Design
Type
RCT (n=266)
Randomization
randomized
Multicenter
Yes
Structured PICO
Does prophylactic ICD implantation reduce all-cause mortality in high-risk patients after primary percutaneous coronary intervention for ST-segment-elevation myocardial infarction?
P
Population
266 high-risk patients (mean age 60.8 years, 21.8% female) with ST-segment-elevation myocardial infarction treated with primary percutaneous coronary intervention, followed for 3 years.
I
Intervention
Prophylactic implantable cardioverter defibrillator (ICD) implantation 30 to 60 days after MI
C
Comparator
Conventional medical therapy
O
Outcome
All-cause mortality at 3 years follow-uphard clinical
Main Result
Hazard Ratio: 0.37 (95% CI 0.15–0.95)
Absolute Event Rate: 5% vs 13%
Early prophylactic ICD implantation (30-60 days post-MI) in high-risk STEMI patients treated with primary PCI significantly reduced long-term total and cardiac mortality.
Limitations
- Prematurely terminated and thus underpowered
- prematurely terminated
- underpowered
Cite This Study
Haanschoten et al. (2020) conducted an RCT in ST-segment-elevation myocardial infarction (n=266). Prophylactic implantable cardioverter defibrillator (ICD) implantation vs. Conventional medical therapy was evaluated on All-cause mortality at 3 years follow-up (HR 0.37, 95% CI 0.15-0.95). Prophylactic ICD implantation significantly reduced all-cause mortality compared to conventional medical therapy at 3 years (5% vs 13%; HR 0.37, 95% CI 0.15-0.95) in high-risk STEMI patients.