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Previous Volume 346:877-883 March 21, 2002 Number 12 Next

	Full Text PDF PDA Full Text PowerPoint Slide Set Editorial by Bigger, J. T. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

ABSTRACT

Background Patients with reduced left ventricular function after myocardial infarction are at risk for life-threatening ventricular arrhythmias. This randomized trial was designed to evaluate the effect of an implantable defibrillator on survival in such patients.

Methods Over the course of four years, we enrolled 1232 patients with a prior myocardial infarction and a left ventricular ejection fraction of 0.30 or less. Patients were randomly assigned in a 3:2 ratio to receive an implantable defibrillator (742 patients) or conventional medical therapy (490 patients). Invasive electrophysiological testing for risk stratification was not required. Death from any cause was the end point.

Results The clinical characteristics at base line and the prevalence of medication use at the time of the last follow-up visit were similar in the two treatment groups. During an average follow-up of 20 months, the mortality rates were 19.8 percent in the conventional-therapy group and 14.2 percent in the defibrillator group. The hazard ratio for the risk of death from any cause in the defibrillator group as compared with the conventional-therapy group was 0.69 (95 percent confidence interval, 0.51 to 0.93; P=0.016). The effect of defibrillator therapy on survival was similar in subgroup analyses stratified according to age, sex, ejection fraction, New York Heart Association class, and the QRS interval.

Conclusions In patients with a prior myocardial infarction and advanced left ventricular dysfunction, prophylactic implantation of a defibrillator improves survival and should be considered as a recommended therapy.

Source Information

From the Cardiology Unit of the Department of Medicine (A.J.M, W.Z., J.P.D, M.W.B., M.L.A.) and the Department of Biostatistics (W.J.H.), University of Rochester Medical Center, Rochester, N.Y.; the Division of Cardiology, University Hospital, Magdeburg, Germany (H.K.); the Cardiology Unit, Loyola University Medical Center, Maywood, Ill. (D.J.W.); Cardiology Associates, Good Samaritan Hospital, Los Angeles (D.S.C.); and the Department of Cardiology, Scripps Memorial Hospital, La Jolla, Calif. (S.L.H.).

Address reprint requests to Dr. Moss at the Heart Research Follow-up Program, Box 653, University of Rochester Medical Center, Rochester, NY 14642, or at heartajm{at}heart.rochester.edu.

Full Text of this Article

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Implantable Cardiac Defibrillators
Donaldson R. M. Jr., Stecker E. C., Pollack H. A., Carbajal E. V., Smith R. G., Cohen S. E., Gollapudi A. K., Spivack C., Moss A. J., Hall W. J., Zareba W.
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N Engl J Med 2002; 347:365-367, Aug 1, 2002. Correspondence

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