Defibrillator Implantation Early after Myocardial Infarction

Steinbeck, Gerhard; Andresen, Dietrich; Seidl, Karlheinz; Brachmann, Johannes; Hoffmann, Ellen; Wojciechowski, Dariusz; Kornacewicz-Jach, Zdzisława; Średniawa, Beata; Lupkovics, Géza; Hofgärtner, F.; Lubiński, Andrzej; Rosenqvist, Mårten; Habets, Alphonsus; Wegscheider, Karl; Senges, Jochen

doi:10.1056/nejmoa0901889

Cited by 622 publications

(429 citation statements)

References 30 publications

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“…27 The Defibrillator and Acute Myocardial Infarction (DINAMIT) and IRIS trials prospectively randomized patients with significantly impaired ventricular function (ejection fractions of <0.35 and <0.40, respectively), along with other risk factors, to receive an ICD shortly (mean, 18 and 13 days, respectively) after AMI. 28,29 In both trials, the lower rates of sudden death in the ICD arms were paralleled by concomitant increases in nonarrhythmic mortality such that total mortality was ultimately no different in the ICD-treated and medically treated groups. Taken together, these findings do not support a survival benefit from early implanted/permanent defibrillator placement for primary prevention in otherwise high-risk patients.…”

Section: Table 1 Applying Classification Of Recommendations and Levementioning

confidence: 99%

“…Similar findings were demonstrated in the IRIS trial. 29 The WCD may have a role as a bridge for prevention of SCD in the first 40 days after infarction in patients who are considered to have an increased risk of arrhythmic death. This very population is the subject of the aforementioned VEST, a randomized, clinical trial that should help to clarify the role of the WCD in this patient population.…”

Section: After MImentioning

confidence: 99%

See 1 more Smart Citation

Wearable Cardioverter-Defibrillator Therapy for the Prevention of Sudden Cardiac Death

Piccini¹,

Allen²,

Kudenchuk³

et al. 2016

Circulation

119

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Section: Table 1 Applying Classification Of Recommendations and Levementioning

confidence: 99%

Section: After MImentioning

confidence: 99%

Wearable Cardioverter-Defibrillator Therapy for the Prevention of Sudden Cardiac Death

Piccini¹,

Allen²,

Kudenchuk³

et al. 2016

Circulation

119

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“…Current guidelines do not preclude octogenarians and nonagenarians from receiving ICDs for primary prevention unless they have < 1-year life expectancy [1]. In primary prevention ICD trials, which constitute the basis for current clinical practice, more than 50% of enrolled patients were younger than 60 years [49,53,58,59,85]. In real-world practice, nearly 70% of ICDs are implanted in patients older than 60 years, and more than 40% are implanted in patients older than 70 years [83].…”

Section: Agementioning

confidence: 99%

Implantable Cardioverter-Defibrillators in Sudden Cardiac Death Prevention: What Guidelines Don't Tell

Giaccardi¹,

Colella²,

Santoro³

et al. 2013

Cardiac Defibrillation

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“…83 This was a randomised, prospective, multicentre trial which enrolled 898 patients, 5-31 days after their AMI, who met the following clinical criteria: LVEF ≤40% and a heart rate ≥90 bpm on the first available ECG or non-sustained VT (≥150 bpm) during Holter monitoring. The main difference between this study and DINAMIT was a contemporary patient population (70% had undergone PCI and the majority were receiving optimal long-term medication) and additional non-invasive criteria to identify a population at potentially higher risk.…”

Section: Risk Stratification For Sudden Cardiac Death and Implantablementioning

confidence: 99%

Almanac 2011: Cardiac arrhythmias and pacing. The national society journals present selected research that has driven recent advances in clinical cardiology

Liew

2012

Revista Portuguesa de Cardiologia

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eDitoRiaL AtriAl fibrillAtion Clinical trialsIn the past 2 years, a number of landmark clinical trials have been published which further our understanding and clinical management of patients with atrial fibrillation (AF). Two of the major goals in the treatment of this condition include reducing progression or recurrence of the arrhythmia and decreasing the risk of cardiovascular events, thereby improving quality of life and decreasing morbidity. Following on from a large body of evidence from preclinical studies, small clinical trials and meta-analyses suggesting that blockade of the renin-angiotensin system has beneficial effects on the pathophysiology of AF, 1 two large multicentre, placebo-controlled, randomised trials were conducted to determine the effects of angiotensin II receptor blockers (ARBs) on AF.The first of these trials, published in 2009, tested the hypothesis that the ARB valsartan could reduce the recurrence of AF in patients with underlying cardiovascular disease, diabetes or left atrial enlargement and a history of documented AF, in addition to established treatments. 2 A total of 1442 patients were enrolled into the study-722 assigned to the valsartan group (target dose 320 mg) and 720 to the placebo group. The investigators found that treatment with valsartan had no significant effect on AF recurrence (AF recurrence 51.4% in the valsartan group and 52.1% in the placebo group, p=0.73) over a relatively short follow-up period of 1 year.The second large ARB randomised controlled trial (RCT) published this year evaluated whether irbesartan would reduce the risk of cardiovascular events in patients with AF. 3 Patients with a history of risk factors for stroke and a systolic blood pressure of at least 110 mm Hg were randomly assigned to receive either irbesartan (target dose of 300 mg once daily) or placebo. Patients for this study were already enrolled in one of two other AF trials looking at clopidogrel plus aspirin versus aspirin alone or versus oral anticoagulants. The investigators found that irbesartan did not reduce cardiovascular events or hospitalisation rates for AF (total of 9016 enrolled with a mean follow-up of 4.1 years) and that, not surprisingly, more patients in the irbesartan group had symptomatic hypotension and renal dysfunction than those in the placebo group.Although the main findings from both of these large RCTs were negative, it should be noted that they were secondary prevention studies-that is, patients already had established AF, and also had more advanced stages of disease (over 80% of patients in both studies had a history of persistent or permanent AF), implying that the substrate for AF was already well established in both study groups. It might be argued that blockade of the renin-angiotensin system may be a more effective strategy if performed earlier during the natural history of the disease or even before AF develops (ie, primary prevention), since ACE inhibitors and ARBs may prevent, but not necessarily reverse, the electrical and structural remodelling that ...

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Defibrillator Implantation Early after Myocardial Infarction

Cited by 622 publications

References 30 publications

Wearable Cardioverter-Defibrillator Therapy for the Prevention of Sudden Cardiac Death

Wearable Cardioverter-Defibrillator Therapy for the Prevention of Sudden Cardiac Death

Implantable Cardioverter-Defibrillators in Sudden Cardiac Death Prevention: What Guidelines Don't Tell

Almanac 2011: Cardiac arrhythmias and pacing. The national society journals present selected research that has driven recent advances in clinical cardiology

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