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Previous Volume 351:2481-2488 December 9, 2004 Number 24 Next

	Full Text PDF PDA Full Text PowerPoint Slide Set Editorial by Gillis, A. M. Editorial by Jauhar, S. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited E-mail When Letters Appear PubMed Citation

ABSTRACT

Background Implantable cardioverter–defibrillator (ICD) therapy has been shown to improve survival in patients with various heart conditions who are at high risk for ventricular arrhythmias. Whether benefit occurs in patients early after myocardial infarction is unknown.

Methods We conducted the Defibrillator in Acute Myocardial Infarction Trial, a randomized, open-label comparison of ICD therapy (in 332 patients) and no ICD therapy (in 342 patients) 6 to 40 days after a myocardial infarction. We enrolled patients who had reduced left ventricular function (left ventricular ejection fraction, 0.35 or less) and impaired cardiac autonomic function (manifested as depressed heart-rate variability or an elevated average 24-hour heart rate on Holter monitoring). The primary outcome was mortality from any cause. Death from arrhythmia was a predefined secondary outcome.

Results During a mean (±SD) follow-up period of 30±13 months, there was no difference in overall mortality between the two treatment groups: of the 120 patients who died, 62 were in the ICD group and 58 in the control group (hazard ratio for death in the ICD group, 1.08; 95 percent confidence interval, 0.76 to 1.55; P=0.66). There were 12 deaths due to arrhythmia in the ICD group, as compared with 29 in the control group (hazard ratio in the ICD group, 0.42; 95 percent confidence interval, 0.22 to 0.83; P=0.009). In contrast, there were 50 deaths from nonarrhythmic causes in the ICD group and 29 in the control group (hazard ratio in the ICD group, 1.75; 95 percent confidence interval, 1.11 to 2.76; P=0.02).

Conclusions Prophylactic ICD therapy does not reduce overall mortality in high-risk patients who have recently had a myocardial infarction. Although ICD therapy was associated with a reduction in the rate of death due to arrhythmia, that was offset by an increase in the rate of death from nonarrhythmic causes.

Source Information

From J.W. Goethe University, Frankfurt (S.H.H.), and St. Georg's Hospital, Hamburg (K.H.K.) — both in Germany; St. Michel's Hospital, Toronto (P.D.), and Hamilton Civic Hospitals Research Center (R.S.R., M.G.) and McMaster University (S.J.C.), Hamilton, Ont. — all in Canada; University Hospital, Nottingham, United Kingdom (J.R.H.); Slovak Cardiovascular Institute, Bratislava, Slovak Republic (R.H.); and St. Jude Medical, Sunnyvale, Calif. (E.F.).

Address reprint requests to Dr. Hohnloser at the Department of Medicine, Division of Cardiology, J.W. Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany, or at hohnloser{at}em.uni-frankfurt.de.

Full Text of this Article

Related Letters:

Implantable Cardioverter–Defibrillator Therapy after Myocardial Infarction
Shah K. B., Gottlieb S. S., Steinbeck G., Andresen D., Senges J., Micheletta F., Natoli S., Iuliano L., Hohnloser S. H., Connolly S. J., Gent M., the DINAMIT Investigators
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N Engl J Med 2005; 352:1039-1041, Mar 10, 2005. Correspondence

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