Document Detail


Optimal timing of implantable cardioverter-defibrillator implantation after myocardial infarction: a decision analysis.
MedLine Citation:
PMID:  20132397     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The optimal timing of implantable cardioverter defibrillator (ICD) placement for the primary prevention of sudden cardiac death after myocardial infarction (MI) remains unknown. METHODS AND RESULTS: We developed a Markov model to investigate the optimal timing of ICD implantation after MI (no ICD, ICD at 60 days, 6 months, and 1 year) in patients who meet current guidelines. Estimates of arrhythmic death (baseline risk 6%, range 1-20% per year), nonarrhythmic death, and ICD efficacy were based upon MADIT-II and other contemporary post-MI clinical trials. We used both deterministic and stochastic modeling processes in our analysis. After 10 years follow-up, the baseline probability of survival was higher in those treated with ICD implantation versus not (42% vs 30%, P < 0.001). Survival was highest with ICD implantation at 60 days versus 6 months versus 1 year: 42.4%, 42.3%, and 42.0% (P = 0.0028). ICD implantation at 60 days provided a mean incremental survival of 0.28 months and 0.84 months per patient (compared with implantation at 6 months and 1 year). In sensitivity analyses, patients' competing risk for nonarrhythmic death was the primary determinant of benefit from ICD implantation. Overall, ICD implantation at 60 days resulted in the greatest life expectancy over a wide range of plausible nonarrhythmic and arrhythmic death rates. CONCLUSIONS: The benefits of early ICD implantation are modest when compared with delayed implantation at 6 months/1 year. Our results suggest that making sure a patient receives an ICD, when appropriate, may be more important than the timing of the implantation procedure.
Authors:
Jonathan P Piccini; Sana M Al-Khatib; Evan R Myers; Kevin J Anstrom; Alfred E Buxton; Eric D Peterson; Gillian D Sanders
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Publication Detail:
Type:  Journal Article     Date:  2010-02-01
Journal Detail:
Title:  Journal of cardiovascular electrophysiology     Volume:  21     ISSN:  1540-8167     ISO Abbreviation:  J. Cardiovasc. Electrophysiol.     Publication Date:  2010 Jul 
Date Detail:
Created Date:  2010-07-26     Completed Date:  2010-11-02     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9010756     Medline TA:  J Cardiovasc Electrophysiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  791-8     Citation Subset:  IM    
Affiliation:
Duke Clinical Research Institute and the Duke University School of Medicine, Durham, North Carolina 27705, USA. jonathan.piccini@duke.edu
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MeSH Terms
Descriptor/Qualifier:
Arrhythmias, Cardiac / etiology,  mortality,  physiopathology,  therapy*
Computer Simulation
Death, Sudden, Cardiac / etiology,  prevention & control*
Decision Support Techniques*
Defibrillators, Implantable*
Electric Countershock / instrumentation*
Humans
Markov Chains
Monte Carlo Method
Myocardial Infarction / complications,  mortality,  physiopathology,  therapy*
Patient Selection*
Practice Guidelines as Topic
Reproducibility of Results
Risk Assessment
Risk Factors
Stochastic Processes
Time Factors

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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