Influence of time between last myocardial infarction and prophylactic implantable defibrillator implant on device detections and therapies. “Routine Practice” data from the SEARCH MI registry

Abstract

BackgroundA multicenter European Registry, SEARCH-MI, was instituted in the year 2002 in order to assess patients’ outcomes and ICD interventions in patients with a previous MI and depressed LV function, treated with an ICD according to MADIT II results. In this analysis, we evaluate the influence of the time elapsed between last myocardial infarction (MI) and prophylactic cardioverter defibrillator (ICD) implant on device activations.Methods643 patients with left ventricular dysfunction (mean LVEF 26 ± 5%) and NYHA class I-III were prospectively followed for 1.8 ± 1.2 years in a multicenter registry. The population was divided into 3 groups according to the time between last MI and ICD implant: [1] from 40 days to less than 1.5 years; [2] from 1.5 to less than 7 years and [3] at least 7 years.ResultsThe cumulative incidence of ventricular tachyarrhymias and appropriate device therapy (ATP or shock) were higher in patients implanted longer time from last MI (Gray’s Test p = 0.002 and p = 0.013 respectively). No significant differences were seen in all cause mortality (Gray’s Test p = 0.618) or sudden cardiac death across the MI stratification groups (Gray’s Test p = 0.663).ConclusionsPatients implanted with an ICD longer after the MI have a higher chance of presenting ventricular tachyarrhythmias and appropriate ICD therapy, while no differences were seen in overall mortality. These observations may be important for improving patient targeting in sudden death prevention.

The Effect of Elapsed Time from Myocardial Infarction on Mortality and Major Adverse Cardiac and Cerebrovascular Events in ICD Patients

“…21 In contrast, the SEARCH MI registry observed no differences in all-cause mortality in relation to time between the last MI and ICD implantation. 22 The adjusted HR for all-cause mortality was not statistically significant (HR: 1.02, 95% CI: 0.99-1.05). Previous studies were performed in primary prevention patients.…”

“…In this meta‐analysis, there was scant evidence that time to ICD implantation more than 40 days after MI affects ICD efficacy. Next to the post hoc analyses of randomized clinical trials, the impact of implant time in post‐MI patients was investigated in two prospective registries . The Prevention of Sudden Cardiac Death II (PreSCDII) registry found that late ICD implantation ≥11 months after acute MI was beneficial in mortality reduction, whereas early ICD implantation after acute MI could be even detrimental .…”

“…The Prevention of Sudden Cardiac Death II (PreSCDII) registry found that late ICD implantation ≥11 months after acute MI was beneficial in mortality reduction, whereas early ICD implantation after acute MI could be even detrimental . In contrast, the SEARCH MI registry observed no differences in all‐cause mortality in relation to time between the last MI and ICD implantation . The adjusted HR for all‐cause mortality was not statistically significant (HR: 1.02, 95% CI: 0.99–1.05).…”

“…Next to the post hoc analyses of randomized clinical trials, the impact of implant time in post-MI patients was investigated in two prospective registries. [20][21][22] The Prevention of Sudden Cardiac Death II (PreSCDII) registry found that late ICD implantation ࣙ11 months after acute MI was beneficial in mortality reduction, whereas early ICD implantation after acute MI could be even detrimental. 21 In contrast, the SEARCH MI registry observed no differences in all-cause mortality in relation to time between the last MI and ICD implantation.…”

Clinical valuation of ST changes in a group of patients with ventricular arrhythmias: The inSighT Study

“…It has been documented that long-term mortality risk among ICD patients with IHD is correlated with the time elapsed from last coronary revascularization (Barsheshet et al, 2011). Similarly, it is proven that patients implanted with an ICD longer after the myocardial infarction have a higher chance of developing ventricular tachyarrhythmias (Boriani et al, 2012).…”