| Optimal timing of implantable cardioverter-defibrillator implantation after myocardial infarction: a decision analysis. | |
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MedLine Citation:
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PMID: 20132397 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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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:
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Type: Journal Article Date: 2010-02-01 |
Journal Detail:
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Title: Journal of cardiovascular electrophysiology Volume: 21 ISSN: 1540-8167 ISO Abbreviation: J. Cardiovasc. Electrophysiol. Publication Date: 2010 Jul |
Date Detail:
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Created Date: 2010-07-26 Completed Date: 2010-11-02 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 9010756 Medline TA: J Cardiovasc Electrophysiol Country: United States |
Other Details:
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Languages: eng Pagination: 791-8 Citation Subset: IM |
Affiliation:
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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:
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Arrhythmias, Cardiac
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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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