AI Article Synopsis
- The study investigates the best timing for placing implantable cardioverter-defibrillators (ICDs) in patients post-myocardial infarction (MI) and whether this timing affects outcomes such as mortality and complications.
- Analysis of data from nine clinical trials shows that patients receiving ICDs had lower mortality rates compared to those who did not, regardless of the timing of the implant after MI.
- The research concludes that the timing of ICD implantation beyond 40 days after MI does not significantly influence its effectiveness or the occurrence of rehospitalizations and complications.
Article Abstract
Background: Whether there is an optimal time to place an implantable cardioverter-defibrillator (ICD) more than 40 days after myocardial infarction (MI) in guideline-eligible patients is unknown.
Objective: To evaluate the effect of time from MI to randomization on mortality, rehospitalizations, and complications.
Methods: Individual data on patients enrolled in 9 primary prevention ICD trials were provided. Clinical trials were eligible for the current analysis if they enrolled patients with an MI more than 40 days prior to randomization to primary prevention ICD therapy vs usual care: Multicenter Automatic Defibrillator Implantation Trial I, Multicenter UnSustained Tachyardia Trial, Multicenter Automatic Defibrillator Implantation Trial II, and Sudden Cardiac Death in Heart Failure Trial.
Results: ICD recipients died less frequently than nonrecipients at 5 years across all subgroups of time from MI to randomization. In unadjusted Cox proportional hazards regression, a survival benefit was evident in most subgroups. Adjusted Bayesian Weibull survival modeling yielded hazard ratio (HR) 0.50, 95% posterior credible interval (PCI) 0.20-1.25 41-180 days after MI; HR 0.98, 95% PCI 0.37-2.37 181-365 days after MI; HR 0.22, 95% PCI 0.07-0.59>1-2 years after MI; HR 0.42, 95% PCI 0.17-0.90>2-5 years after MI; HR 0.55, 95% PCI 0.25-1.15>5-10 years after MI; and HR 0.48, 95% PCI 0.20-1.02>10 years after MI. There was no evidence of an interaction between time from MI and all-cause mortality, rehospitalizations, or complications.
Conclusions: In this meta-analysis, there was scant evidence that the efficacy of primary prevention ICD therapy depends on time to implantation more than 40 days after MI. Similarly, there was no evidence that the risks of rehospitalizations or complications depend on time more than 40 days after MI.
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| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4037291 | PMC |
| http://dx.doi.org/10.1016/j.hrthm.2013.02.011 | DOI Listing |
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